Do I need prednisone (corticosteroid) for adhesive capsulitis?

Corticosteroids for Adhesive Capsulitis

Yes, you should consider corticosteroids for adhesive capsulitis, as they provide significant short-term pain relief and functional improvement, with intra-articular injections showing superior results compared to oral steroids.

Evidence for Corticosteroid Use

Oral Corticosteroids

• Oral prednisolone 30 mg daily for 3 weeks provides significant short-term benefit in adhesive capsulitis, with marked improvement in pain (mean change 4.1 vs 1.4 in placebo), disability, range of motion, and patient-rated improvement (marked/moderate improvement in 96% vs 48% of patients) 1
• However, benefits are not maintained beyond 6 weeks, with outcomes tending to favor placebo by 12 weeks 1
• High-dose pulse prednisolone (500 mg IV for 3 consecutive days) combined with NSAIDs and physiotherapy reduces pain more effectively than NSAIDs and physiotherapy alone (pain scale decreased to 2.96 vs 4.9) 2

Intra-Articular Corticosteroid Injections

• Intra-articular corticosteroid injections are more effective than oral steroids for adhesive capsulitis, showing superior results in objective shoulder scores, range of motion, and patient satisfaction 3
• Meta-analysis demonstrates that intra-articular injections provide effective pain relief in the short term (0-8 weeks) compared to placebo, though this advantage diminishes at 9-24 weeks 4
• Range of motion improvements persist both short-term and long-term (0-8 weeks and 9-24 weeks) with intra-articular injections 4
• Both intra-articular and subacromial injection sites are effective, with no clinically significant differences between the two approaches, though subacromial injection may avoid larger fluctuations in blood glucose 5

Recommended Treatment Algorithm

First-Line Approach

• Start with intra-articular corticosteroid injection (either glenohumeral or subacromial approach) as it provides superior outcomes compared to oral steroids 3
• Combine with physiotherapy and NSAIDs for optimal results 2
• Expect significant pain relief and functional improvement within 4 weeks 3

Alternative Oral Regimen

• If injection is not feasible or patient preference dictates, use oral prednisolone 30 mg daily for 3 weeks 1
• Counsel patients that benefits may not persist beyond 6 weeks 1
• Consider high-dose pulse therapy (500 mg IV prednisolone for 3 days) for more severe cases 2

Series of Injections

• Three intra-articular injections can be administered as a treatment series, showing sustained improvement in Constant-Murley scores, Simple Shoulder Test results, and range of motion at 4 weeks and beyond 3

Important Clinical Considerations

Timing and Expectations

• Maximum benefit occurs at 3-4 weeks after initiation of treatment 1, 3
• Pain relief from intra-articular injections is more sustained than oral steroids but still diminishes after 8 weeks 4
• Range of motion improvements with injections persist longer than pain relief 4

Safety Profile

• Subacromial injections may cause less blood glucose fluctuation compared to intra-articular injections 5
• Both oral and injectable routes lead to fast pain relief and improved range of motion 3
• Monitor for typical corticosteroid adverse effects including hyperglycemia

Integration with Other Therapies

• Corticosteroids should be combined with physiotherapy for optimal outcomes 2
• NSAIDs can be used concurrently (e.g., diclofenac 100 mg/day) 2
• Physical therapy should continue throughout and after corticosteroid treatment

Common Pitfalls to Avoid

• Do not rely solely on oral steroids when intra-articular injection is available, as injections provide superior objective outcomes 3
• Do not expect long-term sustained benefits from a single short course of oral prednisolone beyond 6 weeks 1
• Do not use prolonged courses of oral corticosteroids, as the evidence supports only short courses (3 weeks) 1
• Do not delay physiotherapy while waiting for corticosteroid effects; these treatments work synergistically 2