From the Research
Corticosteroid injections are generally considered the better first-line injectate option for adhesive capsulitis (frozen shoulder) compared to platelet-rich plasma (PRP). The most recent and highest quality study 1 suggests that combining corticosteroid injections with physical therapy may provide greater improvement than physiotherapy alone. A common regimen involves a single intra-articular injection of methylprednisolone (40-80mg) or triamcinolone acetonide (40mg) mixed with local anesthetic (such as 4-5ml of 1% lidocaine) 2. The injection should be followed by a structured physical therapy program to maximize benefits. Corticosteroids work by reducing inflammation in the joint capsule, which is particularly beneficial during the inflammatory "freezing" phase of adhesive capsulitis. Some studies suggest that a lower dose of corticosteroid, such as 20mg of triamcinolone acetonide, may be sufficient to elicit symptom relief in patients with severe adhesive capsulitis 3, 4. While PRP shows promise for tissue healing and may have fewer side effects than steroids, its benefits for adhesive capsulitis typically take longer to manifest and current evidence suggests its outcomes are not superior to corticosteroids for this specific condition. Key points to consider when using corticosteroid injections for adhesive capsulitis include:
- Patients with diabetes should be monitored for potential blood glucose elevation following steroid injection
- The injection should not be repeated more than 2-3 times within a 12-month period to avoid potential tissue damage
- Combining corticosteroid injections with physical therapy may provide greater improvement than physiotherapy alone
- A lower dose of corticosteroid may be sufficient to elicit symptom relief in some patients.