From the Guidelines
You can consider receiving steroid injections after adhesive capsulitis release surgery, but the decision should be made in consultation with your orthopedic surgeon, as individual circumstances vary. The use of steroid injections in this context is not well-studied, and the evidence is largely based on expert opinion and case series. However, some studies suggest that corticosteroid injections into the glenohumeral joint or subacromial space can be effective in reducing shoulder pain, including in patients with hemiplegic shoulder pain 1. When considering steroid injections after adhesive capsulitis release surgery, it is essential to weigh the potential benefits against the potential risks, including temporary pain flare, skin discoloration, and elevated blood sugar in diabetic patients. Some key points to consider include:
- The timing of the injection, with most surgeons recommending waiting at least 2-4 weeks after surgery to allow initial healing
- The type and dose of steroid used, with common options including triamcinolone acetonide (20-40mg) or methylprednisolone (40-80mg)
- The use of ultrasound guidance to ensure accurate administration of the injection into the glenohumeral joint
- The potential for multiple repeated injections to weaken tendons and other structures over time, and the need to avoid this if possible. Ultimately, the decision to use steroid injections after adhesive capsulitis release surgery should be made on a case-by-case basis, taking into account the individual patient's circumstances and medical history.
From the Research
Adhesive Capsulitis Treatment
- Adhesive capsulitis, also known as "frozen shoulder," is a common shoulder condition characterized by pain and decreased range of motion, especially in external rotation 2.
- The most effective treatment for adhesive capsulitis is uncertain, but nonsurgical treatments include nonsteroidal anti-inflammatory drugs, short-term oral corticosteroids, intra-articular corticosteroid injections, physiotherapy, acupuncture, and hydrodilatation 2.
Corticosteroid Injections
- Corticosteroid injections can provide significant symptom relief for 2 to 24 weeks 3.
- A 20 mg dose of triamcinolone may be as effective as a 40 mg injection 4, 3.
- Injections can be performed intra-articularly or into the subacromial space, and evidence suggests that ultrasound-guided injections may be beneficial 5, 3.
Post-Surgery Considerations
- Surgical treatment options for patients who have minimal improvement after six to 12 weeks of nonsurgical treatment include manipulation under anesthesia and arthroscopic capsule release 2.
- There is no direct evidence to suggest that corticosteroid injections should not be used after adhesive capsulitis release surgery, but the efficacy and safety of this treatment approach in the post-surgical period are unclear.
Key Findings
- Corticosteroid injections demonstrate short-term efficacy, but may not provide a long-term benefit 3.
- The use of corticosteroid injections is generally safe, with infrequent and minor side effects 6.
- Physicians may consider corticosteroid injection to treat adhesive capsulitis, especially in the early stages when pain is the predominant presentation 6.