An observational study to compare the outcome of local steroid injections and ultrasonic wave therapy in frozen shoulder patients

Abstract

Background: Frozen shoulder is described as a painful shoulder condition of insidious onset associated with stiffness and disturbance in sleep due to pain in shoulder on the affected side1. Frozen shoulder is associated with synovitis and capsule contracture though it is never associated with capsular adhesions. The condition leads to a loss of range of movements of shoulder joint3. FS is a self-limiting disease. Various management options are available and in this study we compared the effects of physiotherapy modality Ultrasonic wave therapy with intraarticular steroid injections. Steroids are known to reduce inflammatory cascade and manipulation in any of the modalities reduce the adhesions. Material and Methods: 100 patients of frozen shoulder were divided in 2 groups (50 patients each) with nonspecific pain and stiff shoulder not treated over a period of one month by conventional analgesics. In Group 1 Patients treated with two intraarticular steroid while in group 2 Patients treated with ultrasonic wave therapy. Diagnosis of frozen shoulder was confirmed by ultrasonography of shoulder. Outcomes were accessed with SPADI score & Pre and post treatment VAS (visual analog scale) for pain. Observations: Group I patients with intraarticular injections showed better improvement manifested as increased range of motion and significant improvement in SPADI score at Day 7 as compared to group 2. But at later stage that is at Day 21 and 60, improvement in both the groups was similar as shown in Table 1 and graphs. Internal rotation at the end of 60 days was upto D12 in group 1 & 2 both. External rotation was 80.4(±10.6) while in group 2 was 78.8 (±11.4) at the end of day 60. Abduction in group 1 was 169.2(±11.4) in group 2 it was 168.4 (SD±8.2) at day 60. SPADI score was 6.4% (SD±7.6) in group 1 while in group 2 it was 7.2% (SD±9.6). VAS score was 1.2 in group 1 while in group 2 it was 1.5 at day 60. Results and Conclusions: Immediate improvement is better with intra articular injections but overall long term results are very much similar in both the injection and physiotherapy groups. For any of the acute situations, intra articular injections may be tried to provide immediate relief but both the therapies are providing same degree of rehabilitation over a longer period. Otherwise also a long therapy with proper compliance of patient and supervised exercise protocol is mandatory for adhesive capsulitis of shoulder joint.