2017 ISAKOS Biennial Congress ePoster #2207
How Much Should We Inject of Steroid Injection for Treatment of Primary Shoulder Stiffness: A Prospective Randomized Controlled Trial with High- And Low-Dose Steroid Injection
In Park, MD, Seoul KOREA, REPUBLIC OF
Yang-Soo Kim, MD, PhD, Prof., Seoul KOREA, REPUBLIC OF
Hyo-Jin Lee, MD, Prof., Seoul KOREA, REPUBLIC OF
Hong-Ki Jin, MD, Busan KOREA, REPUBLIC OF
Dong-Hyuk Sun, MD, Seoul, Seoul KOREA, REPUBLIC OF
Sung-Ryeoll Park, MD, Seoul KOREA, REPUBLIC OF
Jin Hong Kim, MD, Seoul KOREA, REPUBLIC OF
Dongjin Kim, MD, Seoul KOREA, REPUBLIC OF
Jong-Ho Kim, MD, Seoul KOREA, REPUBLIC OF
Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, KOREA, REPUBLIC OF
FDA Status Cleared
The optimal dose of triamcinolone for the treatment of shoulder stiffness is still controversial. By comparing two different doses(20mg vs 40mg) of intraarticular triamcinolone, this study proved the efficacy of intraarticular triamcinolone injection regardless of the dose and recommended to use lower dose due to short-term increase in blood glucose for diabetic patients.
Intra-articular corticosteroid injection has a proven effect on recovery of range of motion (ROM) and pain in patients with shoulder stiffness, yet the optimal dose is still controversial. The purpose of the study was to compare the efficacy and complications of intra-articular corticosteroid injection at two different doses in patients with shoulder stiffness.
From July 2011 to August 2012, 147 patients with shoulder stiffness were randomly assigned to receive Ultrasound guided intra-articular injection of either 40mg (group I, n=76) or 20mg (group II, n=71) of triamcinolone acetonide. The outcome measures including ROM, ASES score, pain assessed by visual analog scale (VAS) and simple shoulder test score were evaluated at 3, 6, and 12 weeks, 6 and 12 months, and at the last follow-up. Among the patients with controlled diabetes, the levels of blood glucose, fructosamine, and HbA1c were measured to evaluate systemic serologic changes induced by local steroid treatment at 6 and 12 weeks post-injection.
There was no significant difference in demographic data between the two groups. There were significant improvements in ROM, functional scores, and pain VAS in both groups at the last follow-up after treatment. However, there were no significant differences in any of the parameters between the two groups at each time point. None of the diabetic patients in both groups had a significant increase in blood glucose, fructosamine, and HbA1c levels compared with levels before injection. However, those in group I showed significantly higher blood glucose levels at 6 weeks after injection compared with those in group II (p=0.01).
Intra-articular injection of corticosteroid is a reliable method for improving symptoms in patients with shoulder stiffness with no significant differences between high and low dose. However, in diabetic patients a lower dose of corticosteroid is recommended because short-term glucose level may increase with a high dose.