Intra-articular distension and steroids in the management of capsulitis of the shoulder

OBJECTIVE--To determine whether there is any synergistic effect in the administration of intraarticular steroids with distension in the management of early capsulitis of the shoulder. DESIGN--Prospective randomised trial of three treatments--namely distension only, steroid only, and steroid with distension. SETTING--Academic department of orthopaedic and accident surgery at Queen's Medical Centre, Nottingham. SUBJECTS--47 patients (30 women) with capsulitis affecting 50 shoulders. INTERVENTIONS--Three intra-articular injections into the shoulder given at six week intervals by the same technique. MAIN OUTCOME MEASURES--Passive range of abduction, forward flexion, and external rotation; results of shoulder dynamometry measuring work done and torque produced; pain levels at rest and with resisted movement. RESULTS--All patients reported improvement during the study. Analysis of the mean improvements in abduction and forward flexion showed these to be significantly greater in the steroid with distension and steroid only groups than in the distension only group (mean improvements in abduction (degrees/week (95% confidence interval)) 4.3 (3.4 to 5.2), 3.4 (2.4 to 4.5), and 1.0 (-0.8 to 2.8) in the three groups respectively; mean improvements in flexion (degrees/week (95% confidence interval)) 3.6 (3.2 to 4.0), 3.3 (2.3 to 4.3), and 1.5 (0.5 to 2.5) respectively). Shoulder dynamometry failed to show a significant difference among the treatment groups. No severe complications occurred as a result of the injections, but two patients reported facial flushing related to the use of steroids. CONCLUSION--Intra-articular steroid injections have a useful role in the outpatient management of early capsulitis.