Published online Sep 18, 2018. doi: 10.5312/wjo.v9.i9.165
Peer-review started: April 7, 2018
First decision: June 14, 2018
Revised: July 1, 2018
Accepted: August 2, 2018
Article in press: August 3, 2018
Published online: September 18, 2018
To investigate the additional value of physiotherapy after a corticosteroid injection in stage one or two idiopathic frozen shoulders (FSs).
A two center, randomized controlled trial was done. Patients with a painful early stage idiopathic FS were eligible for inclusion. After written consent, patients were randomly allocated into two groups. All patients received an ultrasound-guided intra-articular corticosteroid injection. One group underwent additional physiotherapy treatment (PT) and the other group did not (non-PT). The primary outcome measure was the Shoulder Pain and Disability Index (SPADI). Secondary outcomes were pain (numeric pain rating scale), range of motion (ROM), quality of life (RAND-36 score), and patient satisfaction. Follow-up was scheduled after 6, 12 and 26 wk.
Twenty-one patients were included, 11 patients in the non-PT and ten in the PT group, with a mean age of 52 years. Both treatment groups showed a significant improvement at 26 wk for SPADI score (non-PT: P = 0.05, PT: P = 0.03). At the 6 wk follow-up, median SPADI score was significant decreased in the PT group (14 IQR: 6-38) vs the non-PT group (63 IQR: 45-76) (P = 0.01). Pain decreased significantly in both groups but no differences were observed between both treatment groups at any time point, except for night pain at 6 wk in favor of the PT group (P = 0.02). Significant differences in all three ROM directions were observed after 6 wk in favor of the PT group (P ≤ 0.02 for all directions). A significantly greater improvement in abduction (P = 0.03) and external rotation (P = 0.04) was also present in favor of the PT group after 12 wk. RAND-36 scores showed no significant differences in health-related quality of life at all follow-up moments. At 26 wk, both groups did not differ significantly with respect to any of the outcome parameters. No complications were reported in both groups.
Additional physiotherapy after corticosteroid injection improves ROM and functional limitations in early-stage FSs up to the first three months.
Core tip: Corticosteroids and physiotherapy are the most widely used treatment modalities in frozen shoulders (FSs). However, the role of physiotherapy, especially in early FSs, is controversial. Corticosteroid injection with additional physiotherapy leads to better Shoulder Pain and Disability Index scores and range of motion up to three months compared to corticosteroid injection alone. Although a trend was recognized in favor of the physiotherapy group, both groups did not differ significantly with respect to any of the outcome parameters at the final follow-up after 26 wk.