Serial Intrarticular Low Dose Corticosteroid Injections for Frozen Shoulder Pain Management: A Case Report

Abstract

Idiopathic frozen shoulder (IFS), follows a three-phase progression of synovial inflammation to adhesive synovitis, to more mature adhesions with less synovitis, and finally mature adhesions. [1] In early stage 1 & II disease, a one-off 80 mg intra-articular corticosteroid injection (CSI) has reported efficacy in dampening cytokine-mediated pain and inflammation, and chemically ablating the synovitis early, which may prevent fibrosis and shorten the course of disease. [2] However, hydrodilation with steroid-only injection studies report inconclusive results. [3] Other reports advocate an early one-off 80 mg CSI as the customary management. Veteran clinicians however, have reported anecdotal success with much smaller doses of serial 20 mg depo-steroid injections, performed depending on symptoms, at 1-8 week intervals. This approach methodology has found some recent support in the literature. [4]. Many IFS patients are also diabetics, [5] and serial lower dose CSI may avoid serum glucose fluctuations in diabetic patients.