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Adhesive capsulitis: one sonographic-guided injection of 20 mg triamcinolon into the rotator interval

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Abstract

The aim of this study was to establish a method for injecting corticosteroid into the rotator interval under sonographic guidance and to measure the effect on function, pain and range of motion after 4 and 12 weeks. This study involved a multicenter cohort trial and carried out at outpatient clinics of the physical medicine and rehabilitation departments in Oslo and Porsgrunn, Norway. 39 patients with adhesive capsulitis lasting between 3 and 12 months. Sonographic-guided corticosteroid and lidocaine injection into the rotator interval medial to the biceps tendon using 20 mg triamcinolon hexacetat and 3 ml 20 mg/ml xylocain. Change in the shoulder pain and disability index score (SPADI) after 12 weeks. The change in SPADI was 42 points (95 % confidence interval, 33–51). Changes in the secondary outcomes shoved highly statistically significant increase in active and passive range of motion. One ultrasound-guided corticosteroid injection into the rotator interval seems to give significant improvement in SPADI and active range of motion after 12 weeks. The protocol was evaluated by the research faculty at Oslo university hospital, dept of physical medicine. The study was regarded as regular clinical procedure as injections with triamcinolon already is standard treatment. No trial registration was obtained but the protocol presented the local ethics committee without comments.

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References

  1. Hand C, Clipsham K, Rees JL, Carr AJ (2008) Long-term outcome of frozen shoulder. J Shoulder Elbow Surg 17:231–236

    Article  Google Scholar 

  2. Hand GC, Athanasou NA, Matthews T, Carr AJ (2007) The pathology of frozen shoulder. J Bone Joint Surg Br 89:928–932

    Article  CAS  Google Scholar 

  3. Neviaser AS, Neviaser RJ (2011) Adhesive capsulitis of the shoulder. J Am Acad Orthop Surg 19:536–542

    Article  Google Scholar 

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

    Google Scholar 

  5. Wolf EM, Cox WK (2010) The external rotation test in the diagnosis of adhesive capsulitis. Orthopedics 33 [Epub ahead of print]

  6. Lee JC, Sykes C, Saifuddin A, Connell D (2005) Adhesive capsulitis: sonographic changes in the rotator cuff interval with arthroscopic correlation. Skeletal Radiol 34:522–527

    Article  CAS  Google Scholar 

  7. Uhthoff HK, Boileau P (2007) Primary frozen shoulder: global capsular stiffness versus localized contracture. Clin Orthop Relat Res 456:79–84

    Article  Google Scholar 

  8. Favejee MM, Huisstede BM, Koes BW (2011) Frozen shoulder: the effectiveness of conservative and surgical interventions—systematic review. Br J Sports Med 45:49–56

    Article  CAS  Google Scholar 

  9. Carette S et al (2003) Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial. Arthritis Rheum 48:829–838

    Article  CAS  Google Scholar 

  10. Buchbinder R, Green S, Youd JM, Johnston RV, Cumpston M (2008) Arthrographic distension for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev 1:CD007005

    Google Scholar 

  11. Tveita EK, Tariq R, Sesseng S, Juel NG, Bautz-Holter E (2008) Hydrodilatation, corticosteroids and adhesive capsulitis: a randomized controlled trial. BMC Musculoskelet Disord 9:53

    Article  Google Scholar 

  12. Walters J, Howes F, Buchbinder R (2007) Oral corticosteroids—their place in the management of adhesive capsulitis. Aust Fam Physician 36:927–929

    PubMed  Google Scholar 

  13. Harris JD, Griesser MJ, Copelan A, Jones GL (2011) Treatment of adhesive capsulitis with intra-articular hyaluronate: a systematic review. Int J Shoulder Surg 5:31–37

    Article  Google Scholar 

  14. De CA et al (2012) Shoulder adhesive capsulitis: manipulation and arthroscopic arthrolysis or intra-articular steroid injections? Int Orthop 36:101–106

    Article  Google Scholar 

  15. Blanchard V, Barr S, Cerisola FL (2010) The effectiveness of corticosteroid injections compared with physiotherapeutic interventions for adhesive capsulitis: a systematic review. Physiotherapy 96:95–107

    Article  Google Scholar 

  16. Austgulen OK, Oyen J, Hegna J, Solheim E (2007) Arthroscopic capsular release in treatment of primary frozen shoulder. Tidsskr Nor Laegeforen 127:1356–1358

    PubMed  Google Scholar 

  17. Griesser MJ, Harris JD, Campbell JE, Jones GL (2011) Adhesive capsulitis of the shoulder: a systematic review of the effectiveness of intra-articular corticosteroid injections. J Bone Joint Surg Am 93:1727–1733

    Article  Google Scholar 

  18. Swartz SL, Dluhy RG (1978) Corticosteroids: clinical pharmacology and therapeutic use. Drugs 16:238–255

    Article  CAS  Google Scholar 

  19. Gaskill TR, Braun S, Millett PJ (2011) Multimedia article. The rotator interval: pathology and management. Arthroscopy 27:556–567

    Article  Google Scholar 

  20. Petchprapa CN et al (2010) The rotator interval: a review of anatomy, function, and normal and abnormal MRI appearance. AJR Am J Roentgenol 195:567–576

    Article  Google Scholar 

  21. Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y (1991) Development of a shoulder pain and disability index. Arthritis Care Res 4:143–149

    Article  CAS  Google Scholar 

  22. Breckenridge JD, McAuley JH (2011) Shoulder pain and disability index (SPADI). J Physiother 57:197

    Article  Google Scholar 

  23. Staples MP, Forbes A, Green S, Buchbinder R (2009) Shoulder-specific disability measures showed acceptable construct validity and responsiveness. J Clin Epidemiol 63(2):163–70. http://du114w.dub114.mail.live.com/mail/RteFrame_16.2.7137.1204.html?dl=dl#

    Article  Google Scholar 

  24. Tveita EK, Ekeberg OM, Juel NG, Bautz-Holter E (2008) Responsiveness of the shoulder pain and disability index in patients with adhesive capsulitis. BMC Musculoskelet Disord 9:161

    Article  Google Scholar 

  25. Williams JW Jr, Holleman DR Jr, Simel DL (1995) Measuring shoulder function with the shoulder pain and disability index. J Rheumatol 22:727–732

    PubMed  Google Scholar 

  26. Schmitt JS, Di Fabio RP (2004) Reliable change and minimum important difference (MID) proportions facilitated group responsiveness comparisons using individual threshold criteria. J Clin Epidemiol 57:1008–1018

    Article  Google Scholar 

  27. Angst F et al (2008) Responsiveness of six outcome assessment instruments in total shoulder arthroplasty. Arthritis Rheum 59:391–398

    Article  Google Scholar 

  28. Ekeberg OM et al (2009) Subacromial ultrasound guided or systemic steroid injection for rotator cuff disease: randomised double blind study. BMJ 338:a3112

    Article  Google Scholar 

  29. Oh JH et al (2011) Comparison of glenohumeral and subacromial steroid injection in primary frozen shoulder: a prospective, randomized short-term comparison study. J Shoulder Elbow Surg 20:1034–1040

    Article  Google Scholar 

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Correspondence to Niels Gunnar Juel.

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Juel, N.G., Oland, G., Kvalheim, S. et al. Adhesive capsulitis: one sonographic-guided injection of 20 mg triamcinolon into the rotator interval. Rheumatol Int 33, 1547–1553 (2013). https://doi.org/10.1007/s00296-012-2503-4

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  • DOI: https://doi.org/10.1007/s00296-012-2503-4

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