What is the best injectate for adhesive capsulitis (frozen shoulder)?

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From the FDA Drug Label

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From the Research

For adhesive capsulitis, corticosteroid injections are generally considered the best injectate option, particularly triamcinolone acetonide (20mg) mixed with local anesthetic, as it has been shown to be as effective as a 40mg dose 1. The injection should be delivered into the glenohumeral joint or subacromial space under ultrasound guidance when possible to ensure accurate placement.

  • A single injection is often sufficient, though some patients may require a repeat injection after 6-8 weeks if symptoms persist.
  • Corticosteroids work by reducing inflammation in the joint capsule, which helps decrease pain and improve range of motion during the painful freezing phase of the condition.
  • This allows patients to more effectively participate in physical therapy, which remains essential for long-term recovery.
  • Alternative injectates include hyaluronic acid and saline hydrodilatation (capsular distension), but these have shown less consistent results than corticosteroids 2, 3.
  • Patients should be informed that improvement may not be immediate, with maximum benefit typically occurring 2-3 weeks post-injection, and should continue prescribed stretching exercises to maintain and improve mobility gains.
  • Early injection may be considered to shorten the natural history of adhesive capsulitis, as it has been shown to improve outcomes at both short- and long-term follow-ups 4.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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