Intra-articular Steroid in the Management of Adhesive Capsulitis of Shoulder: A Comparison of the Anterior and Posterior Approaches

Abstract

Abstract Objective To compare the anterior and posterior blind intra-articular steroid injections approaches in the management of adhesive capsulitis of shoulder Design Randomised control trial Setting Department of PMR, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur. Participants The patients having adhesive capsulitis of shoulder (n=60) attending PMR department, RIMS during the study period. Duration One year (August 2011 to July 2012). Intervention After randomisation, 60 patients were allocated in three groups (A, B and C). Group C (n=20) received physical therapy practice in the department of PMR, RIMS, Imphal. Group A (n=18) and B (n=22) received intraarticular steroid (methylprednisolone 80mg each) by anterior and posterior approaches without imaging guidance respectively in addition to physical therapy. Outcome measures: 1) Visual analogue scale (VAS) for pain, 2) Shoulder pain and disability index (SPADI) and 3) Passive range of motion of affected shoulder using goniometer. Results All the three groups showed improvement with statistically significant (p<0.005) findings in all the outcome variables except in shoulder flexion range (p=0.085). Improvement in outcomes namely VAS, SPADI, shoulder rotation and abduction range were more marked in group A when compared with group B which was found statistically significant (p<0.05). Conclusion The intra-articular steroid injection when combined with physical therapy is effective in the management of adhesive capsulitis of shoulder. The blind anterior approach intra-articular steroid injection is more effective than posterior approach in improving shoulder rotation and abduction range of movements, reducing shoulder pain and disability in patient having less than 3 months duration adhesive capsulitis of shoulder.