Randomized Clinical Trial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2017; 8(5): 394-399
Published online May 18, 2017. doi: 10.5312/wjo.v8.i5.394
Frozen shoulder - A prospective randomized clinical trial
Rudra Narayan Mukherjee, R M Pandey, Hira Lal Nag, Ravi Mittal
Rudra Narayan Mukherjee, Hira Lal Nag, Ravi Mittal, Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi 110029, India
R M Pandey, Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, India
Author contributions: Mukherjee RN, Nag HL and Mittal R planned and conducted this study; Pandey RM helped with the biostatistics for this study; Mukherjee RN and Mittal R wrote this article.
Institutional review board statement: The ethics committee of All India Institute of Medical Sciences, New Delhi, approved the study.
Informed consent statement: All the patients were informed about the study before including them in the study. The informed consent was explained to them in their native language and a written consent was obtained as advised by the ethic committee of our institute. The identity of any of the patients was not disclosed.
Conflict-of-interest statement: All authors declare no conflict of interest related to this paper.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Ravi Mittal, Professor, Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. ravimittal66@hotmail.com
Telephone: +91-11-26594993 Fax: +91-11-26588663
Received: October 12, 2016
Peer-review started: October 15, 2016
First decision: December 15, 2016
Revised: January 26, 2017
Accepted: February 18, 2017
Article in press: February 20, 2017
Published online: May 18, 2017
Abstract
AIM

To compare the results of arthroscopic capsular release with intra-articular steroid injections in patients of frozen shoulder.

METHODS

Fifty-six patients with frozen shoulder were randomised to one of two treatment groups: Group 1, complete 360 degree arthroscopic capsular release and group 2, intra-articular corticosteroid injection (40 mg methyl prednisolone acetate). Both groups were put on active and passive range of motion exercises following the intervention. The outcome parameters were visual analogue scale (VAS) score for pain, range of motion and Constant score which were measured at baseline, 4, 8, 12, 16 and 20 wk after intervention.

RESULTS

All the parameters improved in both the groups. The mean VAS score improved significantly more in the group 1 as compared to group 2 at 8 wk. This greater improvement was maintained at 20 wk with P value of 0.007 at 8 wk, 0.006 at 12 wk, 0.006 at 16 wk and 0.019 at 20 wk. The Constant score showed a more significant improvement in group 1 compared to group 2 at 4 wk, which was again maintained at 20 wk with P value of 0.01 at 4, 8, 12 and 16 wk. The gain in abduction movement was statistically significantly more in arthroscopy group with P value of 0.001 at 4, 8, 12, 16 wk and 0.005 at 20 wk. The gain in external rotation was statistically significantly more in arthroscopy group with P value of 0.007 at 4 wk, 0.001 at 8, 12, and 16 wk and 0.003 at 20 wk. There was no statistically significant difference in extension and internal rotation between the two groups at any time.

CONCLUSION

Arthroscopic capsular release provides subjective and objective improvement earlier than intra-articular steroid injection.

Keywords: Adhesive capsulitis, Frozen shoulder, Capsular release, Corticosteroid, Idiopathic stiff shoulder, Intra articular injection, Steroid injection, Arthroscopic arthrolysis, Constant score

Core tip: The treatment of frozen shoulder is selected depending on the preference of the treating physician, since there are no guidelines or protocols. The physicians, physiotherapists, occupational therapists and orthopedicians who are not trained in shoulder arthroscopy often select non-surgical methods. On the other hand, shoulder arthroscopists prefer arthroscopic arthrolysis. We conducted a randomised clinical trial to compare the results of arthroscopic arthrolysis and intra-articular steroid injection in frozen shoulder. Both modalities resulted in significant improvement in pain, range of motion and Constant score. However the improvement in surgery group preceded those in injection group by 4-8 wk.