Comparison Between NSAID and Intra-articular Corticosteroid Injection in Frozen Shoulder of Diabetic Patients; a Randomized Clinical Trial

Abstract

Introduction:

Frozen shoulder or adhesive capsulitis is a relatively common encountered musculo-skeletal disease in which arouses following soft tissue involvement of glenohumeral joint and presents with pain and limitation of shoulder’ active and passive motions.

The incidence of frozen shoulder among diabetic patients is about 10–20%, stiffness in such patients is more severe and should be managed actively.

Local Glucocorticoid injection, NSAIDs and physiotherapy each can relief the symptoms. The aim of this study was to compare the efficacy of glenohumeral injection of Glucocorticoid with NSAIDs in frozen shoulder of diabetic patients.

Method:

The randomized clinical trial study conducted during Feb 2009-Aug 2010 on diabetic patients with frozen shoulder that were referred to rheumatology and endocrinology clinics, Yazd, Iran. Diagnostic criteria of capsulitis were pain of shoulder and range of motion limitation in all directions. The patients were divided into 2 groups, patients of first group received NSAID while the latter group were undergone intra-articular corticosteroid injection. After 1 week, home exercise was done for both group and evaluation of the patients after first visit was done likewise 2^nd, 6^th, 12^th and 24^th weeks. All registered data were transformed into SPSS-15 software and analyzed.

Results:

Totally 57 patients (19 males (33.3%) and 38 females (66.7%) were included in the analysis. There was no significant difference between sex (P=0.4) and age (P=0.19) of patients.

No significant relation was detected between 2 groups after 24 weeks according to range of motion in flexion (P=0.51), abduction (P=0.76), external rotation (0.12) and internal rotation (P=0.91). Also any significant difference in pain score was not detected (P=0.91).

Conclusion:

Based on our study, both intra-articular corticosteroid and NSAID are effective in treatment of adhesive capsulitis and there is no significant difference between efficacies of these 2 treatment modalities in diabetic patients.

Key words

frozen shoulder - intra-articular injection - NSAID

• References

• 1 Frieman BG, Albert TJ, Fenlin Jr JM. Rotator cuff disease: A review of diagnosis, pathophysiology and current trends in treatment. Arch Phys Med Rehabil May 1994; 75: 604-609
• 2 Bjelle A. Epidemiology of Shoulder Problems. Baillieres Clin Rheumatol Dec 1989; 3: 437-451
• 3 Palmer KT, Cooperc Walker-Bone K. et al. Use of Keyboards and Symptoms in the Neck and Arm: Evidence From a National Survey. Occup Med 2001; 51: 392-395
• 4 de Jong BA, Dahmen R, Hogeweg JA et al. Intra-Articular Triamcinolone acetonide Injection in Patients with Capsulits of the Shoulder: A comparative Study of Two dose regimes. Clin Rehabil 1998; 12: 211-215
• 5 Macforlane G. Upper Limb Disorders. In: Silman A, Hochberg MC. (eds.). Epidemiology of the rheumatic disease. Oxford Medical Publications; 2001: 339-366
• 6 Ryans I, Montgomery A, Galway R et al. Randomized Controlled Trial of Intra-Articular Triamcinolone and/or Physiotherapy in shoulder Capsulits. Rheumatology (OXFORD) 2005; 44: 522-535
• 7 Sharma S. Management of frozen shoulder – conservative vs surgical?. Ann R Coll Surg Engl Jul 2011; 93: 343-344 discussion 345–346
• 8 Arslan S, Celiker R. Comparison of the Efficiency of Local Corticosteroid Injection and Physical Therapy for the Treatment of Adhesive Capsulits. Rheumatol Int 2001; 21: 20-23
• 9 Buchbinder R, Hoving JL, Green S et al. Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial. Ann Rheum Dis 2004; 63: 1460-1469
• 10 Russell J. Shoulder Adhesive Capsulits: Systematic Review of Randomized Trials Using Multiple Corticosteroid Injections. British Journal of General Practice 2007; 57: 662-667
• 11 Isar Ahmad, Zahid Askar. Intra-articular injection of Methylprednisolone for Idiopathic frozen shoulder. J Med Sci (Pishawar print) 2009; 17: 16-18
• 12 Roh YH, Yi SR, Noh JH et al. Intra-articular corticosteroid injection in diabetic patients with adhesive capsulitis: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc Nov 24 2011;
• 13 Smith F. American College of Rheumatology Intera-Articular Corticosteroids, Supervised Physiotherapy, Adhesive Capsulitis of the Shoulder. Arthritis & Rheumatism 2005; 48: 829-838
• 14 Widiastuti-Samekto M, Sianturi GP. Comparison of oral Route corticosteroid and intra-articular corticosteroid injection. Med J Malaysia 2004; 59: 312-316
• 15 Sakeni RA, Al-Nimer MS. Comparison between intraarticular triamcinolone acetonide and methylprednisolone acetate injections in treatment of frozen shoulder. Saudi Med J 2007; 28: 707-712
• 16 Arroll B, Goodyear-Smith F. Corticosteroid Injections of Painful Shoulder: A Meta-Analysis. Br J Gen Pract 2005; 55: 224-228
• 17 Maund E, Craig D, Suekarran S et al. Management of frozen shoulder: a systematic review and cost-effectiveness analysis. Health Technol Assess 2012; 16: 1-264