Abstract
Idiopathic frozen shoulder is amongst the common problems in orthopedic outpatient department which is characterized by gradual and progressive pain and stiffness of the shoulder joint followed by loss of motion and finally spontaneous recovery over the period of time. Different modalities of treatment are available for Idiopathic frozen shoulder, but none has got universal acceptability. The purpose of this study was to compare the outcome of intra-articular steroid injection and normal saline.
Methods: This was a comparative study done at Government bone and joint surgery hospital Barzulla Srinagar between April 2019 to April 2020, which included 60 patients with Idiopathic Frozen shoulder. There were 30 patients in each group. The mean age of respondent was 57.36 years. Simple Random method of sampling was adopted for selecting patients for each group. Hydroplasty group was given 30ml normal saline 4 ml 2% Lidocain (plain) and 4 ml 0.5% Bupivacain (total volume:40ml) and steroid group was given 2ml Methylprednisolone, 4ml 2% Lidocain(pain), 4ml 0.5% Bupivacain with total volume: 10 ml. Both groups were attached for therapeutic exercises. Comparison of outcomes between two treatment groups was done using Visual Analogue Scale (VAS) for pain, Shoulder Pain and Disability Index for Shoulder function and degree of range of motion.
Statistical analysis was done using SPSS 17.0
Results: There was significant improvement in level of pain, Shoulder function (Shoulder Pain and Disability Index) and range of motion in forward flexion, abduction, external rotation, and internal rotation in four month period in Steroid group compared to normal saline group.
Conclusion: There was a significant improvement in pain, range of movement and Shoulder Pain and Disability Index (SPADI) score in all patients of both group but the difference in improvement was found to be statistically significant in steroid injection group, So steroid injection was found to be more effective treatment modality than normal saline in idiopathic frozen shoulder in short term follow up.
Keywords: Frozen shoulder, Hydroplasty, Intrarticular steroid injection, Shoulder pain and Disability Index.
References
- Bunker TD, Reilly J, Baird KS, et al. Expression of growth factors, Cytokines and matrix metalloproteinases in frozen shoulder. J Bone Joint Surg. (Br) 2000; 82-B: 768-73.
- Jacobs LG, Barton MA, Wallace WA, et al. Intra-articular distension and steroids in the management of capsulitis of the shoulder. BMJ. 1991; 302:1498–1501.
- Rowe CR, Leffert RD. Idiopathic chronic adhesive capsulitis (“frozen shoulder”) In: Rowe CR, editor. The Shoulder. New York: Churchill Livingstone; 1988. pp. 155–163.
- Jacobs LG, Smith MG, Khan SA, Smith K. Manipulation or intra-articular steroids in the management of adhesive capsulitis of the shoulder? A prospective randomized trial. J Shoulder Elbow Surg. 2009; 18:348–353
- Diercks RL and Stevens M. “Gentle thawing of the frozen shoulder: a prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years”. Journal of Shoulder and Elbow Surgery5 (2004): 499-502.
- Hsu JE., et al. “Current review of adhesive capsulitis”. Journal of Shoulder and Elbow Surgery 3 (2011): 502-514.
- Campbell’s operative orthopaedics, volume three/11th edition page: 2625-2627.
- Marx RG., et al. “Intraarticular corticosteroid injection for the treatment of idiopathic adhesive capsulitis of the shoulder”. HSS Journal 2 (2007): 202-207.
- Guyver PM., et al. “Frozen shoulder - a stiff problem that requires a flexible approach”. Maturitas 1 (2014): 11-16.
- Roh YH., et al. “Intra-articular corticosteroid injection in diabetic patients with adhesive capsulitis: a randomized controlled trial”. Knee Surgery, Sports Traumatology, Arthroscopy 10 (2012): 1947-1952.
- Gulzar Saeed Ahmed., et al. “Frozen shoulder: Role of single intra- articular corticosteroid injection and home exercise programs”. Journal of the Liaquat University of Medical and Health Sciences 3 (2011): 138-142.
- Dudkiewiz I., et al. “Idiopathic adhesive Capsulitis, long term results of conservative treatment”. Israel Medical Association Journal 9 (2001): 524-526.
- Neviaser RJ and Neviaser TJ. “The frozen shoulder. Diagnosis and management”. Clinical Orthopaedics 223 (1987): 59 64.
- Hazleman BL. “The painful stiff shoulder”. Rheumatology and Physical Medicine 8 (1972): 413-421.
- Bulgen Dy., et al. “Frozen shoulder: prospective clinical study with an evaluation of three treatment regimen”. Annals of the Rheumatic Diseases 3 (1984): 53-360.
- Sharma RK., et al. “Frozen shoulder syndrome. A comparison of hydraulic distension and manipulation”. International Orthopaedics 5 (1993): 275-278.
- Singh GP., et al. “Comparison of intra-articular steroid vs hydraulic distension for the treatment of frozen shoulder”. Journal of Universal College of Medical Sciences 1 (2013).
- Mohammad Mussa., et al. “Role of intra-articular steroid injection in the management of idiopathic adhesive capsulitis of the shoulder”. International Journal of Contemporary Medical Research 11 (2016): 3222-3223.
- Manvendra Singh Rawat., et al. “Evaluation of the role of intra-articular Steroid injection in frozen shoulder”. International Journal of MOrthopaedics Sciences 1 (2018): 792-794.
Corresponding Author
Prof. Bashir Ahmed Mir
Postgraduate Department of Orthopaedics, Government Medical College Srinagar J&K, India
DOI: https://dx.doi.org/10.18535/jmscr/v8i9.37
