Skip to main content
SpringerLink
Log in

Intra-articular Corticosteroid Injection for the Treatment of Idiopathic Adhesive Capsulitis of the Shoulder

  • Original Article
  • Published:
HSS Journal

Abstract

Treatment for idiopathic adhesive capsulitis or frozen shoulder of the shoulder is controversial. The hypothesis of the study is that intra-articular corticosteroid injection in the early stages of idiopathic adhesive capsulitis will lead to a razpid resolution of stiffness and symptoms. This is a retrospective cohort study of only patients with stage 1 or stage 2 adhesive capsulitis. The diagnosis was made by history and physical examination and only when other causes of pain and motion loss were eliminated. Stage 1 adhesive capsulitis was defined as significant improvement in pain and normalization of motion following intra-articular injection. Stage 2 included patients who had significant improvement in pain and partial improvement in motion following injection. Seven patients with stage 1 and 53 patients with stage 2 comprised the baseline cohort. The mean age was 52 years (range: 30 to 78); 46 patients were female and nine patients had diabetes mellitus. Patients completed a physical examination as well as a shoulder rating questionnaire for symptoms and disability. Criteria for resolution were defined as forward flexion and external rotation to within 15° of the contralateral side and internal rotation to within three spinal levels of the contralateral side. Forty-four of the patients out of 60 met the criteria for recovery at a mean of 6.7 months. The mode and median time to recovery was 3 months. The mean score at final follow-up for 41 patients using the shoulder-rating questionnaire of L’Insalata was 90 (range 52–100). The mean time to recovery for the stage 1 patients was 6 weeks (range: 2 weeks to 3 months), and it was 7 months for stage 2 patients (range: 2 weeks to 2 years). Glenohumeral corticosteroid injection for early adhesive capsulitis may have allowed patients to recover motion at a median time of 3 months. In many cases, the patients had improvement prior to the 3-month mark; however, that was the routine time for follow-up. Patients with stage 1 disease tended to resolve more rapidly than stage 2 patients. Prompt recognition of stage 1 and stage 2 idiopathic adhesive capsulitis and early injection of corticosteroid with local anesthesia may be both diagnostic and therapeutic.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Alman B, Greel D, Ruby L, Al E (1995) Regulation of growth and platelet-derived growth factor expression in palmar fibromatosis (Dupuytren’s disease) by mechanical strain. In: Trans Combined ORS Meeting

  2. Andersen NH, Sojbjerg JO, Johannsen HV, Sneppen O (1998) Frozen shoulder: arthroscopy and manipulation under general anesthesia and early passive motion. J Shoulder Elbow Surg 7(3):218–222

    Article  PubMed  CAS  Google Scholar 

  3. Binder AI, Bulgen DY, Hazleman BL, Roberts S (1984) Frozen shoulder: a long-term prospective study. Ann Rheum Dis 43(3):361–364

    Article  PubMed  CAS  Google Scholar 

  4. Binder A, Hazleman BL, Parr G, Roberts S (1986) A controlled study of oral prednisolone in frozen shoulder. Br J Rheumatol 25(3):288–292

    Article  PubMed  CAS  Google Scholar 

  5. Border WA, Noble NA (1994) Transforming growth factor beta in tissue fibrosis. N Engl J Med 331(19):1286–1292

    Article  PubMed  CAS  Google Scholar 

  6. Bulgen DY, Binder AI, Hazleman BL, Dutton J, Roberts S (1984) Frozen shoulder: prospective clinical study with an evaluation of three treatment regimens. Ann Rheum Dis 43(3):353–360

    PubMed  CAS  Google Scholar 

  7. Bunker TD, Anthony PP (1995) The pathology of frozen shoulder. A Dupuytren-like disease. J Bone Joint Surg Br 77(5):677–683

    PubMed  CAS  Google Scholar 

  8. Dacre JE, Beeney N, Scott DL (1989) Injections and physiotherapy for the painful stiff shoulder. Ann Rheum Dis 48(4):322–325

    PubMed  CAS  Google Scholar 

  9. de Jong BA, Dahmen R, Hogeweg JA, Marti RK (1998) Intra-articular triamcinolone acetonide injection in patients with capsulitis of the shoulder: a comparative study of two dose regimens. Clin Rehabil 12(3):211–215

    Article  PubMed  Google Scholar 

  10. Gam AN, Schydlowsky P, Rossel I, Remvig L, Jensen EM (1998) Treatment of “frozen shoulder” with distension and glucorticoid compared with glucorticoid alone, a randomized controlled trial. Scand J Rheumatol 27:425–430

    Article  PubMed  CAS  Google Scholar 

  11. Grubbs N (1993) Frozen shoulder syndrome: a review of literature. J Orthop Sports Phys Ther 18(3):479–487

    PubMed  CAS  Google Scholar 

  12. Haines JF, Hargadon EJ (1982) Manipulation as the primary treatment of the frozen shoulder. J R Coll Surg Edinb 27(5):271–275

    PubMed  CAS  Google Scholar 

  13. Hannafin JA, DiCarlo EF, Wickiewicz TL, Warren RF (1994) Adhesive capsulitis: capsular fibroplasia of the glenohumeral joint. J Shoulder Elbow Surg 3(Suppl 1):5

    Google Scholar 

  14. Hazleman BL (1972) The painful stiff shoulder. Rheumatol Phys Med 11(8):413–421

    Article  PubMed  CAS  Google Scholar 

  15. Helbig B, Wagner P, Dohler R (1983) Mobilization of frozen shoulder under general anaesthesia. Acta Orthop Belg 49(1–2):267–274

    PubMed  CAS  Google Scholar 

  16. Huskisson EC, Bryans R (1983) Diclofenac sodium in the treatment of painful stiff shoulder. Curr Med Res Opin 8(5):350–353

    PubMed  CAS  Google Scholar 

  17. Hutchinson JW, Tierney GM, Parsons SL, Davis TR (1998) Dupuytren’s disease and frozen shoulder induced by treatment with a matrix metalloproteinase inhibitor. J Bone Joint Surg 80-B(5):907–908

    Article  Google Scholar 

  18. Laroche M, Ighilahriz O, Moulinier L, Constantin A, Cantagrel A, Mazieres B (1998) Adhesive capsulitis of the shoulder: an open study of 40 cases treated by joint distention during arthrography followed by an intraarticular corticosteroid injection and immediate physical therapy. Rev Rhum Engl Ed 65(5):313–319

    PubMed  CAS  Google Scholar 

  19. L’Insalata JC, Warren RF, Cohen SB, Altchek DW, Peterson MG (1997) A self-administered questionnaire for assessment of symptoms and function of the shoulder. J Bone Joint Surg Am 79(5):738–748

    Article  PubMed  CAS  Google Scholar 

  20. Lundberg BJ (1969) The frozen shoulder. Clinical and radiographical observations. The effect of manipulation under general anesthesia. Structure and glycosaminoglycan content of the joint capsule. Local bone metabolism. Acta Orthop Scand Suppl 119:1–59

    PubMed  CAS  Google Scholar 

  21. Mao CY, Jaw WC, Cheng HC (1997) Frozen shoulder: correlation between the response to physical therapy and follow-up shoulder arthrography. Arch Phys Med Rehabil 78(8):857–859

    Article  PubMed  CAS  Google Scholar 

  22. Miller MD, Wirth MA, Rockwood CA Jr (1996) Thawing the frozen shoulder: the “patient” patient. Orthopedics 19(10):849–853

    PubMed  CAS  Google Scholar 

  23. Neviaser JS (1980) Adhesive capsulitis and the stiff and painful shoulder. Orthop Clin North Am 11(2):327–331

    PubMed  CAS  Google Scholar 

  24. Neviaser RJ (1983) Painful conditions affecting the shoulder. Clin Orthop 173:63–69

    PubMed  Google Scholar 

  25. Neviaser RJ, Neviaser TJ (1987) The frozen shoulder. Diagnosis and management. Clin Orthop 223:59–64

    PubMed  Google Scholar 

  26. Ogilvie-Harris DJ, Myerthall S (1997) The diabetic frozen shoulder: arthroscopic release. Arthroscopy 13(1):1–8

    Article  PubMed  CAS  Google Scholar 

  27. Ogilvie-Harris DJ, Biggs DJ, Fitsialos DP, MacKay M (1995) The resistant frozen shoulder. Manipulation versus arthroscopic release. Clin Orthop 319:238–248

    PubMed  Google Scholar 

  28. O’Kane JW, Jackins S, Sidles JA, Smith KL, Matsen FA III (1999) Simple home program for frozen shoulder to improve patients’ assessment of shoulder function and health status. J Am Board Fam Pract 12(4):270–277

    PubMed  CAS  Google Scholar 

  29. Owens-Burkhart H (1991) Management of frozen shoulder. In: Donatelli R (ed) Physical therapy of the shoulder. Churchill Livingstone, New York, pp 91–116

    Google Scholar 

  30. Placzek JD, Roubal PJ, Freeman DC, Kulig K, Nasser S, Pagett BT (1998) Long-term effectiveness of translational manipulation for adhesive capsulitis. Clin Orthop 356:181–191

    Article  PubMed  Google Scholar 

  31. Pollock RG, Duralde XA, Flatow EL, Bigliani LU (1994) The use of arthroscopy in the treatment of resistant frozen shoulder. Clin Orthop 304:30–36

    PubMed  Google Scholar 

  32. Reeves B (1975) The natural history of the frozen shoulder syndrome. Scand J Rheumatol 4(4):193–196

    Article  PubMed  CAS  Google Scholar 

  33. Rodeo SA, Hannafin JA, Tom J, Warren RF, Wickiewicz TL (1997) Immunolocalization of cytokines and their receptors in adhesive capsulitis of the shoulder. J Orthop Res 15(3):427–436

    Article  PubMed  CAS  Google Scholar 

  34. Segmuller HE, Taylor DE, Hogan CS, Saies AD, Hayes MG (1995) Arthroscopic treatment of adhesive capsulitis. J Shoulder Elbow Surg 4(6):403–408

    Article  PubMed  CAS  Google Scholar 

  35. Shaffer B, Tibone JE, Kerlan RK (1992) Frozen shoulder. A long-term follow-up. J Bone Joint Surg Am 74(5):738–746

    PubMed  CAS  Google Scholar 

  36. Steinbrocker O, Argyros TG (1974) Frozen shoulder: treatment by local injections of depot corticosteroids. Arch Phys Med Rehabil 55(5):209–213

    PubMed  CAS  Google Scholar 

  37. van der Windt DAWM, Koes BW, Deville W, Boeke AJP, de Jong BA, Bouter LM (1998) Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care. BMJ 317:1292–1296

    PubMed  Google Scholar 

  38. Warner JJ, Allen A, Marks PH, Wong P (1996) Arthroscopic release for chronic, refractory adhesive capsulitis of the shoulder. J Bone Joint Surg Am 78(12):1808–1816

    PubMed  CAS  Google Scholar 

  39. Zuckerman JD, Cuomo F (1993) Frozen shoulder. In: Matsen FA, Fu FH, Hawkins RJ (eds) The shoulder: a balance of mobility and stability. American Academy of Orthopaedic Surgeons, Rosemont

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Robert G. Marx MD, MSc, FRCSC, Robert W. Malizia MD,  Thomas L. Wickiewicz MD & Jo A. Hannafin MD, PhD

  2. Foster Center for Clinical Outcome Research, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Robert G. Marx MD, MSc, FRCSC

  3. Sports Medicine & Shoulder Reconstruction, Department of Orthopaedic Surgery, University of Cincinnati, 234 Goodman St., Cincinnati, OH, 45219, USA

    Keith Kenter MD

Authors
  1. Robert G. Marx MD, MSc, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert W. Malizia MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Keith Kenter MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas L. Wickiewicz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jo A. Hannafin MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert G. Marx MD, MSc, FRCSC.

Additional information

This project was funded by philanthropic support of Marcia Kapp.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marx, R.G., Malizia, R.W., Kenter, K. et al. Intra-articular Corticosteroid Injection for the Treatment of Idiopathic Adhesive Capsulitis of the Shoulder. HSS Jrnl 3, 202–207 (2007). https://doi.org/10.1007/s11420-007-9044-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11420-007-9044-5

Keywords

Search

Navigation