Can oral steroids (corticosteroids) be given to a patient with frozen shoulder (adhesive capsulitis)?

Oral Steroids for Frozen Shoulder (Adhesive Capsulitis)

Oral steroids can be used as an effective short-term treatment option for patients with frozen shoulder (adhesive capsulitis), particularly during the painful freezing stage when pain and inflammation are most severe.

Evidence-Based Recommendations

The management of frozen shoulder should follow a stepwise approach:

First-Line Treatments

• NSAIDs or acetaminophen for pain relief (Evidence level C) 1
• Physical therapy with gentle stretching and mobilization techniques focusing on external rotation and abduction (Evidence level B) 1
• Activity modification to avoid aggravating movements 1

Second-Line Treatments

• Intra-articular corticosteroid injections are recommended as the preferred steroid delivery method for frozen shoulder 1, 2
  • Rotator interval injection shows better outcomes than intra-articular or subacromial injections 3
  • Low-dose steroid injections are as effective as high-dose injections with fewer side effects 4

When to Consider Oral Steroids

Oral steroids should be considered when:

1. Patients have severe, debilitating pain not responding to first-line treatments
2. Intra-articular injections are contraindicated or not feasible
3. The patient is in the early "freezing" phase (first 1-3 months) of adhesive capsulitis

Oral Steroid Protocol

Based on available evidence, a short course (5-7 days) of oral corticosteroids may be appropriate for very severe or intractable nasal symptoms 5. Applying this principle to frozen shoulder:

• Short course of prednisolone (total dose of 105 mg over approximately three weeks) using a dose-tapering method 6
• Avoid recurrent or prolonged courses due to potential adverse effects 5

Effectiveness and Outcomes

Oral steroid therapy for frozen shoulder has shown highly satisfactory results in improving range of motion:

• Significant improvements in forward flexion (from 102.8° to 136°)
• Improved external rotation (from 11.3° to 33.7°) 6

Important Considerations and Cautions

Potential Side Effects

• Secondary adrenal insufficiency and altered immune response 5
• Myopathy and osteoporosis with prolonged use 5
• Osteonecrosis of the femoral head and osteoporosis with prolonged use 6
• Potential for immunosuppression, especially concerning during infectious disease outbreaks 5

Monitoring

• Evaluate for precipitating causes of adrenal crisis such as infection 5
• Monitor for signs of iatrogenic Cushing's syndrome (bruising, thin skin, edema, weight gain, hypertension, hyperglycemia) 5

Contraindications

• Recurrent parenteral corticosteroid administration is contraindicated 5
• Caution in patients with diabetes, hypertension, or other conditions that may be exacerbated by steroids

Comprehensive Management Approach

For optimal outcomes, combine oral steroids (when indicated) with:

1. Physical therapy with progressive stretching exercises and strengthening of shoulder girdle muscles 1, 7
2. Functional exercises to restore normal movement patterns 1
3. Avoid shoulder immobilization with arm slings or wraps as it can lead to worsening of frozen shoulder 1

Follow-up and Progression

• If full shoulder function is not achieved by 6-8 weeks, intensive physical therapy should be instituted 1
• Consider surgical referral if conservative management fails after 3-6 months 1
• Approximately 80% of patients recover completely within 3-6 months with appropriate conservative treatment 1

Remember that frozen shoulder is often self-limiting, progressing through freezing, frozen, and thawing phases, but appropriate intervention can significantly reduce pain and disability during this process 7.