2015 ISAKOS Biennial Congress ePoster #2114

What is the Optimal Dose of Corticosteroid Injected in Shoulder Stiffness?

Yang-Soo Kim, MD, PhD, Prof., Seoul KOREA, REPUBLIC OF
Department of Orthopedic Surgery, Seoul St. Mary's Hospital, Seoul, KOREA

FDA Status Not Applicable

Summary: Although rapid recovery of range of external rotation was confirmed with high dose intraarticular corticosteroid group, there were no significant differences between the high and low dose of corticosteroid injection in adhesive capsulitis at the last follow-up.

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Abstract:

The intraarticular corticosteroid injection has certified effect on recovery of range of motion(ROM)and pain in adhesive capsulitis of shoulder. But, the optimal dose of corticosteroid is still controversial.

The purpose of this study was to compare the effect of two different doses of corticosteroid on the recovery of function and serologic changes.

From July 2011 to August 2012, 147 patients with primary adhesive capsulitis were randomly assigned to receive ultrasound-guided intraarticular injection of 2cc lidocaine with either 40mg of triamcinolone acetonide (group I, n=76) or 20mg of triamcinolone acetonide (group II, n=71). The outcome measures including (flexion, external rotation at side, external rotation at abduction, internal rotation), ASES score, Constant score were evaluated at 6 weeks, 3, 6, 12 months and at the last follow-up period. The number of patients who were under the medication of diabetes mellitus was evaluated. The level of blood glucose, fructosamine, and HbA1c were measured to evaluate the systemic serologic change of local steroid treatment post-injection 6 & 12 weeks.

There were no significant differences in age, sex, mean follow-up period, initial ROM and functional scores between two groups. Diabetes mellitus patients were 13 and 14 respectively, and there was no significant difference in the level of blood glucose, fructosamine and HbA1C between two groups.
The average follow-up period was 17.7 months. The range of external rotation was significantly better in group I at 3 months after treatment (p<0.05), but there were no differences in other ROM and all functional outcomes including pain VAS between the two groups at the last follow-up. In diabetic patients, group I showed significantly higher level of glucose at 6 weeks after injection than group II. No significant differences were found in the level of fructosamine and HbA1c at each time point. In non-diabetic patients, there were no significant differences in the level of blood glucose, fructosamine and HbA1c.

Although rapid recovery of range of external rotation was confirmed with high dose group, there were no significant differences between the high and low dose of corticosteroid injection in adhesive capsulitis at the last follow-up. Particularly in diabetic patients, as high dose corticosteroid can lead to immediately increase in blood sugar level, lower dose is recommended.