Ranalletta Maximiliano, Rossi Luciano A, Bongiovanni Santiago L, Tanoira Ignacio, Elizondo Cristina M, Maignon Gastón D
Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
Am J Sports Med. 2016 Feb;44(2):474-81. doi: 10.1177/0363546515616238. Epub 2015 Dec 9.
Intra-articular corticosteroid injection is a common therapy for adhesive capsulitis, but there is a lack of prospective randomized controlled studies analyzing the efficacy of single injections applied blindly to accelerate improvement in pain and function.
In patients with adhesive capsulitis, a single intra-articular corticosteroid injection without image control applied before the beginning of a physical therapy program will accelerate pain relief and recovery of function compared with oral nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy.
Randomized controlled trial; Level of evidence, 1.
A total of 74 patients with primary adhesive capsulitis in the freezing stage were randomized to receive either intra-articular injections with betamethasone or oral NSAIDs. Clinical outcome was documented at baseline and after 2, 4, 8, and 12 weeks and comprised a visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) Shoulder Score, the abbreviated Constant-Murley score, and the abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score for function. Passive range of motion was measured with a goniometer.
Patients treated with corticosteroid injections achieved faster pain relief compared with control patients during the first 8 weeks after treatment (P < .001). However, no significant difference in pain was observed among the groups at final follow-up. Likewise, shoulder function and motion improved significantly in both groups at all follow-up points. Shoulder function scores and most motion parameters improved faster in the injection group up to week 8 (P < .001). Again, no significant differences in function or motion were seen at final follow-up.
In patients with adhesive capsulitis, a single corticosteroid injection applied without image control provides faster pain relief and earlier improvement of shoulder function and motion compared with oral NSAIDs.
关节内注射皮质类固醇是治疗肩周炎的常用方法，但缺乏前瞻性随机对照研究来分析盲目单次注射加速疼痛和功能改善的疗效。
在肩周炎患者中，与口服非甾体抗炎药（NSAIDs）和物理治疗相比，在物理治疗计划开始前进行一次无影像引导的关节内皮质类固醇注射将加速疼痛缓解和功能恢复。
随机对照试验；证据等级，1级。
总共74例处于冻结期的原发性肩周炎患者被随机分为接受倍他米松关节内注射或口服NSAIDs治疗。在基线以及2、4、8和12周后记录临床结果，包括疼痛视觉模拟量表（VAS）、美国肩肘外科医师学会（ASES）肩部评分、简化的Constant-Murley评分以及用于功能评估的简化手臂、肩部和手部功能障碍（QuickDASH）评分。使用量角器测量被动活动范围。
与对照组患者相比，接受皮质类固醇注射治疗的患者在治疗后的前8周疼痛缓解更快（P <.001）。然而，在最终随访时，各组之间在疼痛方面未观察到显著差异。同样，在所有随访点，两组的肩部功能和活动均有显著改善。直至第8周，注射组的肩部功能评分和大多数活动参数改善更快（P <.001）。同样，在最终随访时，在功能或活动方面未观察到显著差异。
在肩周炎患者中，与口服NSAIDs相比，一次无影像引导的皮质类固醇注射能更快缓解疼痛，并更早改善肩部功能和活动。
