While adhesive capsulitis has been described as a self-limiting condition, long-term studies suggest that residual pain may occur in up to 50% of patients. As intra-articular steroid injections have been shown to provide significant short-term benefits for pain relief and increased range of motion, this study assessed the effect of a single intra-articular corticosteroid injection, performed without image guidance, when applied before physical therapy.

This blinded, randomized, controlled trial was performed at a single Argentinian center between June of 2012 and June of 2013. Subjects were adult patients with stage II adhesive capsulitis according to the classification of Hannafin and Chiaia. Eighty-seven consecutive patients with frozen shoulder were randomized to receive either a single corticosteroid injection into the glenohumeral joint or oral diclofenac, 75 mg twice a day. All subjects then engaged in a progressive rehabilitation protocol. Clinical and functional parameters were determined at baseline and at two, four, eight and 12 weeks.

The corticosteroid group had faster pain relief and shoulder function improvement during the first eight weeks (P<0.001). At 12 weeks, no significant difference was seen between the groups. Forward flexion, abduction and internal rotation were significantly improved in the steroid group as compared to the control group at all time points (P<0.001).

This study of adults with adhesive capsulitis found that pain and functional improvement, through physical therapy, could be better accelerated with a blind intraarticular steroid, than with oral NSAIDs.