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Corticosteroid Injections for Adhesive Capsulitis

A Review

Xiao, Ryan C. BS*; Walley, Kempland C. BS; DeAngelis, Joseph P. MD, MBA; Ramappa, Arun J. MD

Clinical Journal of Sport Medicine: May 2017 - Volume 27 - Issue 3 - p 308–320
doi: 10.1097/JSM.0000000000000358
Critical Review
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Objective: Adhesive capsulitis is a self-limiting condition in a majority of patients and is often treated nonoperatively. However, symptoms may take 2 to 3 years to resolve fully. A small, but significant, portion of patients require surgical intervention. The purpose of this systematic review is to evaluate the efficacy of corticosteroid injections for the treatment of adhesive capsulitis (AC).

Data Sources: A review of articles indexed by the United States National Library of Medicine was conducted by querying the PubMed database for studies involving participants with AC, frozen shoulder, stiff shoulder, or painful shoulder. Articles that included corticosteroids, glucocorticoids, steroids, and injections were included.

Main Results: Corticosteroid injections provide significant symptom relief for 2 to 24 weeks. Injections can be performed intra-articularly or into the subacromial space. Evidence suggests that a 20 mg dose of triamcinolone may be as effective as a 40 mg injection. It remains unclear whether image-guided injections produce a clinically significant difference in outcomes when compared with landmark-guided (blind) injections. Corticosteroids may be less beneficial for diabetic patients. Patients using protease inhibitors (antiretroviral therapy) should not receive triamcinolone because the drug–drug interaction may result in iatrogenic Cushing syndrome.

Conclusions: Corticosteroid injections for AC demonstrate short-term efficacy, but may not provide a long-term benefit. More high quality, prospective studies are needed to determine whether corticosteroid injections using ultrasound guidance significantly improve outcomes.

*Harvard Medical School, Brookline, Massachusetts;

Department of Orthopaedics, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and

Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Corresponding Author: Ryan C. Xiao, BS, Beth Israel Deaconess Medical Center, Boston, MA 02215 (ryan_xiao@hms.harvard.edu).

The authors report no conflicts of interest.

Received July 28, 2015

Accepted April 19, 2016

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