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Effects of intra-articular steroid injection before pan-capsular release in patients with refractory frozen shoulder

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The purpose of the study was to retrospectively determine the effects of intra-articular steroid injection on the clinical outcome of patients who underwent arthroscopic pan-capsular release for refractory frozen shoulder.


Between 2000 and 2010, 34 patients (20 males, 14 females) who underwent an arthroscopic pan-capsular release for frozen shoulder were included. Intra-articular steroid injections were administered from April 2006, and just before surgery and at the final follow-up, ranges of motion (ROM) and scores of the Shoulder Rating Scale of the University of California, Los Angeles (UCLA) scoring system were evaluated.


Intra-articular steroid injection significantly improved the UCLA scores of pain just before surgery and at the final follow-up (1.7 ± 0.5 vs. 6 ± 2, p < 0.0001). We subdivided the patients into those with and without diabetes mellitus. Steroid injection had a significant effect on the ROM in forward flexion (166.6 ± 8.6 vs. 140 ± 36.1, p = 0.026) and the scores of pain (10 vs. 9.3 ± 1.2, p = 0.046) at the final follow-up in the group without diabetes mellitus compared with those with it.


Intra-articular steroid injection improves pain just before an arthroscopic pan-capsular release and at the final follow-up in all the patients with refractory frozen shoulder. However, it improves the ROM in forward flexion and the UCLA scores of pain at the final follow-up only in those without diabetes mellitus.

Level of evidence

Therapeutic studies, Level IV.

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  1. 1.

    Ando A, Sugaya H, Hagiwara Y, Takahashi N, Watanabe T, Kanazawa K, Itoi E (2013) Identification of prognostic factors for the nonoperative treatment of stiff shoulder. Int Orthop 37:859–864

  2. 2.

    Arslan S, Celiker R (2001) Comparison of the efficacy of local corticosteroid injection and physical therapy for the treatment of adhesive capsulitis. Rheumatol Int 21:20–23

  3. 3.

    Binder A, Hazleman BL, Parr G, Roberts S (1986) A controlled study of oral prednisolone in frozen shoulder. Br J Rheumatol 25:288–292

  4. 4.

    Bot SD, van der Waal JM, Terwee CB, van der Windt DA, Scholten RJ, Bouter LM, Dekker J (2005) Predictors of outcome in neck and shoulder symptoms: a cohort study in general practice. Spine 30:E459–E470

  5. 5.

    Buchbinder R, Hoving JL, Green S, Hall S, Forbes A, Nash P (2004) Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial. Ann Rheum Dis 63:1460–1469

  6. 6.

    Carette S, Moffet H, Tardif J, Bessette L, Morin F, Frémont P, Bykerk V, Thorne C, Bell M, Bensen W, Blanchette C (2003) Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial. Arthritis Rheum 48:829–838

  7. 7.

    Codman EA (1934) The shoulder. Thomas Todd, Boston, pp 216–224

  8. 8.

    Cuomo F, Flatow EL, Schneider JA, Bishop JY (2005) Idiopathic and diabetic stiff shoulder; Decision-making and treatment. Lippincott Williams & Wilkins, Philadelphia, pp 205–229

  9. 9.

    Diercks RL, Stevens M (2004) Gentle thawing of the frozen shoulder: a prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years. J Shoulder Elb Surg 13:499–502

  10. 10.

    Frank C, Akeson WH, Woo SL, Amiel D, Coutts RD (1984) Physiology and therapeutic value of passive joint motion. Clin Orthop Relat Res 185:113–125

  11. 11.

    Griggs SM, Ahn A, Green A (2000) Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment. J Bone Joint Surg Am 82:1398–1407

  12. 12.

    Hannafin JA, Chiaia TA (2000) Adhesive capsulitis. A treatment approach. Clin Orthop Relat Res 372:95–109

  13. 13.

    Harryman DT, Matsen FA, Sidles JA (1997) Arthroscopic management of refractory shoulder stiffness. Arthroscopy 13:133–147

  14. 14.

    Hay EM, Thomas E, Paterson SM, Dziedzic K, Croft PR (2003) A pragmatic randomised controlled trial of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care. Ann Rheum Dis 62:394–399

  15. 15.

    Jenkins EF, Thomas WJ, Corcoran JP, Kirubanandan R, Beynon CR, Sayers AE, Woods DA (2012) The outcome of manipulation under general anesthesia for the management of frozen shoulder in patients with diabetes mellitus. J Shoulder Elb Surg 21:1492–1498

  16. 16.

    Jerosch J, Nasef NM, Peters O, Mansour AM (2013) Mid-term results following arthroscopic capsular release in patients with primary and secondary adhesive shoulder capsulitis. Knee Surg Sports Traumatol Arthrosc 21:1195–1202

  17. 17.

    Khan AA, Mowla A, Shakoor MA, Rahman MR (2005) Arthrographic distension of the shoulder joint in the management of frozen shoulder. Mymensingh Med J 14:67–70

  18. 18.

    Lafosse L, Boyle S, Kordasiewicz B, Guttierez-Arramberi M, Fritsch B, Meller R (2012) Arthroscopic arthrolysis for recalcitrant frozen shoulder: a lateral approach. Arthroscopy 28:916–923

  19. 19.

    Laslett LL, Burnet SP, Redmond CL, McNeil JD (2008) Predictors of shoulder pain and shoulder disability after one year in diabetic outpatients. Rheumatology (Oxford) 47:1583–1586

  20. 20.

    Le Lievre HM, Murrell GA (2012) Long-term outcomes after arthroscopic capsular release for idiopathic adhesive capsulitis. J Bone Joint Surg Am 94:1208–1216

  21. 21.

    Levine WN, Kashyap CP, Bak SF, Ahmad CS, Blaine TA, Bigliani LU (2007) Nonoperative management of idiopathic adhesive capsulitis. J Shoulder Elb Surg 16:569–573

  22. 22.

    Lorbach O, Anagnostakos K, Scherf C, Seil R, Kohn D, Pape D (2010) Nonoperative management of adhesive capsulitis of the shoulder: oral cortisone application versus intra-articular cortisone injections. J Shoulder Elb Surg 19:172–179

  23. 23.

    Lundberg BJ (1969) The frozen shoulder. Clinical and radiographical observations. The effect of manipulation under general anesthesia. Structure and glycosaminoglycan content of the joint capsule. Local bone metabolism. Acta Orthop Scand Suppl 119:1–59

  24. 24.

    Mifflin KA, Kerr BJ (2014) The transition from acute to chronic pain: understanding how different biological systems interact. Can J Anaesth 61:112–122

  25. 25.

    Miller MD, Wirth MA, Rockwood CA (1996) Thawing the frozen shoulder: the “patient” patient. Orthopedics 19:849–853

  26. 26.

    Rao SR, Saltzman CL, Wilken J, Yak HJ (2006) Increased passive ankle stiffness and reduced dorsiflexion range of motion in individuals with diabetes mellitus. Foot Ankle Int 27:617–622

  27. 27.

    Reeves B (1966) Arthrographic changes in frozen and post-traumatic stiff shoulders. Proc R Soc Med 59:827–830

  28. 28.

    Reeves B (1975) The natural history of the frozen shoulder syndrome. Scand J Rheumatol 4:193–196

  29. 29.

    Ryans I, Montgomery A, Galway R, Kernohan WG, McKane R (2005) A randomized controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis. Rheumatology (Oxford) 44:529–535

  30. 30.

    Shaffer B, Tibone JE, Kerlan RK (1992) Frozen shoulder. A long-term follow-up. J Bone Joint Surg Am 74:738–746

  31. 31.

    Sheridan MA, Hannafin JA (2006) Upper extremity: emphasis on frozen shoulder. Orthop Clin North Am 37:531–539

  32. 32.

    Vastamäki H, Kettunen J, Vastamäki M (2012) The natural history of idiopathic frozen shoulder: a 2- to 27-year followup study. Clin Orthop Relat Res 470:1133–1143

  33. 33.

    Vermeulen HM, Rozing PM, Obermann WR, le Cessie S, Vlieland TPV (2006) Comparison of high-grade and low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder: randomized controlled trial. Phys Ther 86:355–368

  34. 34.

    Yian EH, Contreras R, Sodl JF (2012) Effects of glycemic control on prevalence of diabetic frozen shoulder. J Bone Joint Surg Am 94:919–923

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Correspondence to Yoshihiro Hagiwara.

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Hagiwara, Y., Sugaya, H., Takahashi, N. et al. Effects of intra-articular steroid injection before pan-capsular release in patients with refractory frozen shoulder. Knee Surg Sports Traumatol Arthrosc 23, 1536–1541 (2015). https://doi.org/10.1007/s00167-014-2936-2

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  • Intra-articular steroid injection
  • Frozen shoulder
  • Adhesive capsulitis
  • Pan-capsular release