From the Guidelines
Steroid injections after adhesive capsulitis release surgery can help loosen a tight shoulder capsule by reducing inflammation and pain, allowing for more effective physical therapy, as supported by the use of intra-articular injections of Triamcinolone, which have been found to have significant effects on pain 1. When considering the management of adhesive capsulitis, it's essential to prioritize a multimodal approach that includes physical therapy, pain management, and potentially steroid injections. The study by Price and Pandyan, as mentioned in 1, highlights the benefits of intra-articular injections in improving pain and range of motion, although the improvements in range of motion were not significant. Key considerations for the use of steroid injections in this context include:
- The timing of the injection, typically within the first few weeks after surgery
- The dosage and type of corticosteroid used, such as triamcinolone 40mg or methylprednisolone 40-80mg
- The importance of administering the injection under ultrasound guidance to ensure accurate placement within the glenohumeral joint
- The need for concurrent physical therapy to maintain and improve capsular mobility, with exercises performed multiple times daily and supervised therapy sessions 2-3 times weekly While steroid injections can be beneficial, the most crucial component for preventing recurrence of capsular tightness is consistent physical therapy with stretching exercises, which should begin within days after surgery and continue for 2-3 months, as this provides the necessary mechanical stretching to maintain long-term capsular mobility.
From the Research
Effect of Steroid Injection on Adhesive Capsulitis
- Steroid injections are a common treatment for adhesive capsulitis, also known as "frozen shoulder" 2.
- The injections can help reduce pain and improve range of motion, especially when combined with physiotherapy 2, 3.
- Studies have shown that corticosteroid injections can be effective in treating adhesive capsulitis, with improvements in pain and function compared to placebo or physiotherapy alone 4, 3, 5.
Dosage of Corticosteroid Injections
- Research suggests that a low dose of corticosteroid (20 mg of triamcinolone acetonide) is sufficient to elicit symptom relief in patients with severe adhesive capsulitis, and may be recommended as the initial dose 4, 5.
- High-dose corticosteroid injections (40 mg of triamcinolone acetonide) may not provide additional benefits compared to low-dose injections 4, 5.
Arthroscopic Capsular Release
- For patients who do not respond to conservative management, arthroscopic capsular release may be an effective treatment option 6.
- This procedure allows for precise release of thickened capsular tissue, which can help improve range of motion and reduce pain 6.
Effect of Steroid Injection after Adhesive Capsulitis Release Surgery
- There is limited evidence specifically addressing the effect of steroid injections after adhesive capsulitis release surgery on loosening a tight capsule.
- However, steroid injections have been shown to be effective in reducing inflammation and improving range of motion in patients with adhesive capsulitis, which may suggest a potential benefit in loosening a tight capsule after surgery 2, 3.