Comparative Effectiveness of Corticosteroid Dosages for Ultrasound-Guided Glenohumeral Joint Hydrodilatation in Adhesive Capsulitis: A Randomized Controlled Trial |
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| Institution: | 1. Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan;2. School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan;3. Department of Physical Medicine and Rehabilitation, West Garden Hospital, Taipei, Taiwan;4. Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan;5. Division of General Surgery, Department of Surgery, Shin-Kong Memorial Hospital, Taipei, Taiwan;6. School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan;7. Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan;1. Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States;2. Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States;3. United States Public Health Service, Atlanta, GA, United States;1. UCLA Department of Medicine, Los Angeles, CA;2. Health Care Division, RAND Corporation, Santa Monica, CA;3. Patient Reported Outcomes, Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women''s Hospital, Boston, MA;1. NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia;2. Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia;3. School of Medical and Health Sciences, Edith Cowan University, Perth, Australia;4. Queensland Aphasia Research Centre, University of Queensland, Brisbane, Australia;5. Faculty of Health and Behavioural Sciences, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia;6. Melbourne Medical School, University of Melbourne, Parkville, Australia;7. Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia;8. Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh PA;9. Geriatric Research, Education, and Clinical Center and Audiology and Speech Pathology Service, VA Pittsburgh Healthcare System, Pittsburgh PA;10. Brain Recovery and Rehabilitation Group, Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia;11. School of Psychological Sciences, Macquarie University, Sydney, Australia;1. Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA;2. Department of Gerontology, University of Massachusetts Boston, Boston, MA;3. Medical Practice Evaluation Center and Center for Aging and Serious Illness, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA;4. Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark;5. Department of Clinical Medicine, University of Copenhagen, Denmark;6. New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA;7. Harvard Medical School, Boston, MA;8. Boston University, Boston, MA;9. Brigham and Women''s Hospital, Boston, MA;10. Geriatrics and Extended Care, VA Boston Healthcare System, Boston, MA;11. Spaulding Rehabilitation Hospital, Boston, MA;1. Department of Rehabilitation Psychology and Neuropsychology, Rehabilitation Institute of Michigan, Detroit, MI;2. Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI;3. Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI |
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| Abstract: | ObjectiveTo investigate the efficacy of hydrodilatation with 40 mg triamcinolone acetonide (TA) compared with the same procedure with 10 mg TA in patients with adhesive capsulitis (AC) of the shoulders.DesignProspective, double-blind, randomized controlled trial with 12 weeks of follow-up.SettingTertiary care rehabilitation center.ParticipantsEighty-four patients diagnosed with AC (N=84).InterventionsUltrasound guidance using (A) hydrodilatation with 4 mL of TA (40 mg)+4 mL 2% lidocaine hydrochloride+12 mL normal saline or (B) hydrodilatation with 1 mL of TA (10 mg)+4 mL 2% lidocaine hydrochloride+15 mL normal saline through the posterior glenohumeral recess.Main Outcome MeasuresShoulder Pain and Disability Index (SPADI), visual analog scale (VAS) for pain, and range of motion (ROM) at baseline and at 6 and 12 weeks after injection.ResultsBoth groups experienced improvements in the SPADI score, VAS scores for pain, and ROM throughout the study period. However, group-by-time interactions were not significant for any outcome measurement at any follow-up time point. No adverse events were reported in either group.ConclusionUltrasound-guided hydrodilatation with 40 and 10 mg TA yielded similar improvements in SPADI, VAS score, and ROM at the 12-week follow-up. Considering the potential detrimental effects of corticosteroids on the adjacent cartilage and tendons, a low dose of TA would be preferable for ultrasound-guided hydrodilatation for AC. |
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| Keywords: | bursitis pain shoulder steroids ultrasonography |
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