Is manipulation under anaesthesia still a better option than intra articular steroid injection in primary frozen shoulder?

Background: Frozen shoulder, also known as adhesive capsulitis, is a common cause of a painful shoulder with restricted motion. The best treatment of frozen shoulder is prevention (secondary frozen shoulder), but early intervention is paramount; a good understanding of the pathologic process by the patient and the physician also is important. The aim of study is comparison between closed manipulation under anaesthesia and intra articular steroid injection in primary periarthritis shoulder.Methods: 30 patients each with primary frozen shoulder who were treated either with closed manipulation under anaesthesia and intra articular steroid injection. The patient is reassessed after 2 weeks, 1 month, 3 month and 6 months using shoulder pain and disability index (SPADI) and visual analogue scales (VAS) to compare the groups.Results: The SPADI index found to be better with patients under went closed manipulation under anaesthesia than intra articular steroid injection in the first 2 weeks. Follow up shows 1st group shows better outcome than 2nd group at 1 month, but later on 3 months and 6 months shows comparable results. VAS score shows initial period of improvement in pain with steroid injection (2nd group). Final follow up shows better pain relief with manipulation under anaesthesia group.Conclusions: The immediate treatment outcome is better with patients with primary frozen shoulder underwent closed manipulation under anaesthesia although following months outcome shows almost equal effectiveness with steroid injection.

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A COMPARATIVE PROSPECTIVE STUDY TO EVALUATE THE RESULTS OF PHYSICAL THERAPY V/S INTRAARTICULAR STEROID INJECTION IN PERIARTHRITIS OF SHOULDER

10.36106/ijsr/6535975 ◽

2021 ◽

pp. 46-48

Author(s):

Nilabh Kumar ◽

Laljee Chaudhary ◽

Debarshi Jana

Keyword(s):

Physical Therapy ◽

Side Effects ◽

Steroid Injection ◽

Therapy Group ◽

Adhesive Capsulitis ◽

Frozen Shoulder ◽

Response To Treatment ◽

Disability Score ◽

Injection Group

Background: Frozen shoulder or adhesive capsulitis is a condition where the patient experience stiffness and pain in joint of the shoulder. It is an enigma as till now its etiology is unknown. It affects both the genders of the middle and elderly age. A retrospective, comparative study was to evaluate the effects of physical therapy versus intra-articular steroid injection in periarthritis of shoulder. Methods: 30 patients each with frozen shoulder who were treated either using physical therapy (Group 1) and intra-articular steroid injection (Group 2). The data was collected at baseline and at different follow-up periods and analyzed. Results: There were 3 lost to follow-up in physiotherapy group and 4 in intra-articular injection group. Slight male preponderance (51.9% vs. 48.1%) was seen in physiotherapy group. Left side more affected in both the groups. Literacy (p=0.064), socioeconomic status (p=0.22), occupation (p=0.866), comorbidities (p=0.974), abnormal x-ray (p=0.34) were all comparable between the two groups. Mean duration of shoulder pain and restriction of shoulder motion were also comparable (p>0.05). Side effects– 46.2% were higher in intra-articular injection group. Response to treatment, disability score and SPADI index showed signicant reduction in both the groups, but signicantly more reduction in intra-articular injection was seen in comparison to the physiotherapy group. Conclusions: The overall treatment outcome in intra-articular injection group is much better in comparison to the physiotherapy group, but with higher side effects. Intra-articular injection of steroid will prove to be a boon after effective management of side effects.

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STUDY OF RESULT OF FROZEN SHOULDER SYNDROME TREATED WITH INTRAARTICULAR STEROIDS

10.36106/ijsr/2022164 ◽

2021 ◽

pp. 65-66

Author(s):

Yashpal Singh ◽

Mahaveer Meena ◽

Sanjay kumar ghilley

Keyword(s):

Steroid Injection ◽

Corticosteroid Injection ◽

Adhesive Capsulitis ◽

Frozen Shoulder ◽

Prednisolone Acetate ◽

Common Condition ◽

Medical College ◽

Methyl Prednisolone ◽

Shoulder Syndrome

OBJECTIVE: Adhesive capsulitis or frozen shoulder is a common condition that presents with pain and progressive limitation of both active and passive shoulder movements. In this study, we investigate the efcacy of intraarticular steroid injection in case of frozen shoulder. Material & Methods: Study is done on 32 patients of frozen shoulder attended Orthopedic OPD at Jhalawar Medical college, Jhalawar from July 2018 to June 2019. Intra-articular injection of steroid (methyl prednisolone acetate 80 mg) given & results analyzed. RESULTS: Patient follow up done every 2 weeks after giving Intraarticular steroid & advised to exercise of shoulder. Improvement in shoulder pain & movement of shoulder analyzed & recorded up to 12 – 24 weeks. CONCLUSION: Intraarticular injection for frozen shoulder is good, safe & efcient method. For better result corticosteroid injection is given in the early stages when pain is the predominant presentation.

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Functional outcome of manipulation under anaesthesia for the treatment of frozen shoulder

Journal of Fatima Jinnah Medical University ◽

10.37018/krcw7511 ◽

2020 ◽

Vol 14 (1) ◽

pp. 34-40

Author(s):

Yasir Arfat ◽

Muhammad Umer Anwer ◽

Maria Imdad ◽

Faheem Ahmad Usmani ◽

Sana Imdad ◽

...

Keyword(s):

Range Of Motion ◽

Functional Outcome ◽

Adhesive Capsulitis ◽

Frozen Shoulder ◽

Treatment Modalities ◽

Unknown Etiology ◽

Early Recovery ◽

Duration Of Symptoms ◽

Manipulation Under Anaesthesia

Background: Frozen shoulder is defined as painful progressive loss of shoulder movements with unknown etiology. It is a self-limiting disease with the natural history of 18-30 months but with residual pain and restriction of shoulder movement. Its incidence is 2-5%. Various treatment modalities include benign neglect, physical therapy, non-steroidal anti-inflammatory medications, oral glucocorticoids, distention arthrography, intra articular steroid injections, closed manipulation under anaesthesia (MUA) and arthroscopic release of joint capsule. MUA regarding pain control and range of motion is safe, yields immediate results and is very cost effective. The purpose of this study was to ascertain the functional outcome of manipulation under anaesthesia and physiotherapy for the treatment of frozen shoulder in term of safety, cost effectiveness and immediate results. Patients and Methods: In the 6 months study period, 50 patients with adhesive capsulitis were included by non-probability purposive sampling. Manipulation of shoulders was done under general anaesthesia and after the MUA intra articular injection of a mixture of corticosteroid and local anaesthetic was injected. Postoperatively, all patients underwent physiotherapy. Functional outcome was measured using Shoulder Pain and Disability Index (SPADI) preoperatively and postoperatively at 1st, 2nd and 3rd week follow up. Results: Out of 50 patients, 32 (64%) were females and 18 (36%) were males having female to male ratio of 1.8:1. Average age was 51 years and average duration of symptoms preceding to MUA was 4 months and 27 days. The average pain score decreased from 92.52% to 18.08% and the average disability score reduced from 95% to 17.10%, both at 3rd week postoperative follow up. There were no procedure-related complications. Conclusion: Manipulation under anaesthesia along with physiotherapy diminishes pain and disability, improves range of motion and expedites early recovery of function in patients having frozen shoulder.

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Evaluation of results of physical therapy v/s intra articular steroid injection in periarthritis of shoulder: a comparative prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191466 ◽

2019 ◽

Vol 5 (3) ◽

pp. 382

Author(s):

Ravi Kant Jain ◽

Jagdish Nagar ◽

Abhijeet Jayaswal

Keyword(s):

Physical Therapy ◽

Side Effects ◽

Steroid Injection ◽

Therapy Group ◽

Adhesive Capsulitis ◽

Frozen Shoulder ◽

Response To Treatment ◽

Disability Score ◽

Injection Group

Background: Frozen shoulder or adhesive capsulitis is a condition where the patient experience stiffness and pain in joint of the shoulder. It is an enigma as till now its etiology is unknown. It affects both the genders of the middle and elderly age. A retrospective, comparative study was to evaluate the effects of physical therapy versus intra-articular steroid injection in periarthritis of shoulder.Methods: 30 patients each with frozen shoulder who were treated either using physical therapy (Group 1) and intra-articular steroid injection (Group 2). The data was collected at baseline and at different follow-up periods and analyzed.Results: There were 3 lost to follow-up in physiotherapy group and 4 in intra-articular injection group. Slight male preponderance (51.9% vs. 48.1%) was seen in physiotherapy group. Left side more affected in both the groups. Literacy (p=0.064), socioeconomic status (p=0.22), occupation (p=0.866), comorbidities (p=0.974), abnormal x-ray (p=0.34) were all comparable between the two groups. Mean duration of shoulder pain and restriction of shoulder motion were also comparable (p>0.05). Side effects– 46.2% were higher in intra-articular injection group. Response to treatment, disability score and SPADI index showed significant reduction in both the groups, but significantly more reduction in intra-articular injection was seen in comparison to the physiotherapy group.Conclusions: The overall treatment outcome in intra-articular injection group is much better in comparison to the physiotherapy group, but with higher side effects. Intra-articular injection of steroid will prove to be a boon after effective management of side effects.

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ADHESIVE CAPSULITIS; MANAGEMENT BY PHYSIOTHERAPY VERSUS INTRA-ARTICULAR CORTICOSTEROID INJECTION

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i5.5974 ◽

2021 ◽

Vol 71 (5) ◽

pp. 1824-27

Author(s):

Muhammad Umair Hashmi ◽

Babar Bakht Chughtai ◽

Muhammad Nadeem Ahsan

Keyword(s):

Pain Score ◽

Steroid Injection ◽

Corticosteroid Injection ◽

Adhesive Capsulitis ◽

Frozen Shoulder ◽

Sampling Technique ◽

Visual Analogue Pain Scale ◽

Visual Analogue Pain ◽

Group A ◽

Group B

Objective: To determine outcomes of intra-articular corticosteroids injection versus physiotherapy for the treatment of adhesive capsulitis using mean pain score on the visual analogue scale. Study Design: Comparative prospective study. Place and Duration of Study: Orthopedic outpatient department, Bahawal Victoria Hospital Bahawalpur from Jan to Jun 2021. Methodology: A total of 120 cases having adhesive capsulitis (frozen shoulder) were included in the study according to inclusion criteria. Non-probability consecutive sampling technique was used for the selection of cases. Patients were divided into two groups, group-A and group B, each containing 60 cases. Patients in group-A were given intra-articular steroid injection (2ml triamcinolone 40mg ± 2ml of bupivacaine). Patients in group B received ten sessions of physiotherapy by a welltrained physiotherapist under the supervision of an orthopaedic surgeon on alternate days. After six weeks, outcomes were measured in terms of pain score using a visual analogue pain scale. Results: Significant improvement was seen among patients in group-A with mean pain score from 7.32 ± 0.89 measured initially to 5.44 ± 1.37 measured after six weeks (p<0.001). No significant improvement was found among patients in group B with a mean pain score of 7.58 ± 0.94 measured initially to 7.12 ± 0.88 measured after six weeks (p>0.05). Conclusion: Significant improvement in pain relief can be achieved using intra-articular steroid injection administered in the shoulder as compared to supervised sessions of physiotherapy among patients with adhesive capsulitis.

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The efficacy of physiotherapy interventions in the treatment of adhesive capsulitis: A systematic review

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-200186 ◽

2020 ◽

pp. 1-11

Author(s):

Piumi Nakandala ◽

Indumathie Nanayakkara ◽

Surangika Wadugodapitiya ◽

Indika Gawarammana

Keyword(s):

Physical Therapy ◽

Functional Status ◽

Critical Appraisal ◽

Human Subjects ◽

Adhesive Capsulitis ◽

Frozen Shoulder ◽

Randomized Controlled ◽

Search Terms ◽

Evidence Database

BACKGROUND: Adhesive capsulitis is a debilitating condition which causes the capsule of the gleno-humeral joint to thicken and contract progressively. The effectiveness of various non-operative methods has been demonstrated to improve the pain, range of motion (ROM) and functional status of patients with adhesive capsulitis. OBJECTIVE: This study aims to review recent evidence on the efficacy of physiotherapy interventions in the treatment of adhesive capsulitis. METHODS: PubMed, Physiotherapy Evidence Database (PEDro), Science Direct and Cochrane databases were searched for studies published since 2013. The search terms included: Frozen shoulder, adhesive capsulitis, physical therapy, rehabilitation, manual therapy, mobilization, exercise, education, and electrotherapy. The search was limited to studies published in English and studies that used human subjects. RESULTS: Quality scores of 33 articles were reviewed according to the Sackett’s critical appraisal criteria and the grades of recommendation were determined for physiotherapy interventions used in the studies. CONCLUSION: The empirical evidence suggests that certain physical therapy techniques and modalities are strongly recommended for pain relief, improvement of ROM, and functional status in patients with adhesive capsulitis, while others are either moderately or mildly recommended. However, the efficacy of one treatment modality over another is uncertain. The poor methodological rigors demonstrated in most of the reviewed studies emphasize the urgent need of properly conducted, adequately sampled randomized controlled trials with adequate follow up to determine the superior combination of treatment.

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