Effectiveness of Corticosteroids in the Freezing Phase of Adhesive Capsulitis
Corticosteroid injections are highly effective in reducing pain and improving range of motion during the freezing phase of adhesive capsulitis, with significant short-term benefits observed within 2-4 weeks after administration. 1, 2
Mechanism and Evidence
Adhesive capsulitis (frozen shoulder) is characterized by inflammation and adhesions in the shoulder joint capsule, leading to pain and limited range of motion. The condition typically progresses through three phases:
- Freezing phase (painful inflammatory phase)
- Frozen phase (adhesive phase with stiffness)
- Thawing phase (recovery phase)
During the freezing phase, inflammation is the predominant pathological process, making it particularly responsive to corticosteroid therapy. Recent evidence shows:
- Corticosteroid injections provide significant symptom relief for 2-24 weeks 3
- Patients receiving corticosteroid injections demonstrate superior pain reduction and functional improvement at 2-4 weeks compared to hyaluronic acid injections 1
- Targeted injections into the coracohumeral ligament (CHL) and inferior glenohumeral capsule (IGHC) show greater improvement in pain scores and range of motion compared to posterior glenohumeral recess injections 2
Administration Options
Injection Sites
- Intra-articular injections
- Subacromial space injections
- Targeted injections into the coracohumeral ligament and inferior glenohumeral capsule (superior results) 2
Dosing
- 20 mg of triamcinolone appears as effective as 40 mg 3
- Multiple injections may be administered at 2-week intervals if needed 2
Injection Guidance
- Ultrasound-guided injections may improve accuracy, though evidence remains unclear whether they produce clinically significant differences compared to landmark-guided injections 3
Comparative Effectiveness
When comparing administration routes:
- Intra-articular corticosteroid injections show superior results in objective shoulder scores, range of motion, and patient satisfaction compared to oral corticosteroids 4
- Combination therapy with physiotherapy and corticosteroid injections may provide greater improvement than physiotherapy alone 5
Clinical Considerations
Special Populations
- Diabetic patients may experience less benefit from corticosteroid injections 3
- Patients using protease inhibitors should avoid triamcinolone due to potential drug interactions 3
Treatment Timeline
- While traditionally adhesive capsulitis was thought to be self-limiting over 1-2 years, recent evidence suggests persistent functional limitations if left untreated 5
- Early intervention with corticosteroids during the freezing phase may help prevent progression to more severe stages
Conclusion
Corticosteroid injections represent an effective intervention for managing symptoms during the freezing phase of adhesive capsulitis. While they provide excellent short-term relief (2-4 weeks), their long-term benefits may be comparable to other treatments by 6-12 weeks 1. For optimal outcomes, targeted injections into the coracohumeral ligament and inferior glenohumeral capsule appear to provide superior results compared to traditional posterior approach injections 2.