Comparison between Intra-Articular Corticosteroid Injection with Physiotherapy and Corticosteroid Injection Alone in Management of Early Stage Frozen Shoulders: A Randomized Clinical Trial

Abstract

Introduction: Frozen shoulder (FS) is the most prevalent cause of shoulder pain and impairment, affecting 2-4% of all adults. As an appropriate strategy of treatment for FS, supportive physiotherapy treatment (PT) and exercises within the limits of pain has been recommended. Objective: To compare between intra-articular corticosteroid injection with physiotherapy and corticosteroid injection alone in the management of early-stage frozen shoulder. Methods: This prospective randomized clinical trial study was done among 23 patients with symptoms of early-stage (stage I or II) FS in the Department of Orthopedics, Monno Medical College Hospital from July to December 2022. Two groups were formed out of all the patients. While the other group (non-PT) did not receive any additional physiotherapy treatment, one group did. A follow-up was planned for weeks 6, 12, and 26. Results: Patients who had symptoms for ≥6 months was significantly higher in PT group (81.8%) in comparison to non-PT group (p<0.05). Patients who took physiotherapy treatment was significantly higher in PT group (72.7%) in comparison to non-PT group (p<0.05). The median total SPADI scores in the PT group at baseline, which were 82 (IQR: 35-86) and in the non-PT group, which were 80 (IQR: 65-87), showed the significant pain and limitations of frozen shoulder (FS) in its early stages. Both therapy groups significantly improved at the primary endpoint of 6 weeks for SPADI scores (p<0.05). At 6 weeks compared to baseline, passive ROM increased significantly (p<0.05). Each of the three ROM orientations showed significant changes in favor of the PT group after 12 weeks (p<0.05). At 6 weeks after baseline, both pain scores and Rand-36 physical component scale scores significantly increased (p<0.05). Conclusion: In the first 12 weeks of the early stage of frozen shoulder, physiotherapy in addition to corticosteroid injection improves range of motion (ROM) and functional mobility limitations compared ............