Predictive Factors for Failure of Intraarticular Injection in Management of Adhesive Capsulitis of the Shoulder

Abstract

Intraarticular (IA) corticosteroid injections have been demonstrated to be an effective management for adhesive capsulitis in both the short- and mid-term. Yet, certain patients fail to improve both subjectively and clinically. This study aims to identify predictive factors for treatment failure of IA injections in management of adhesive capsulitis. A retrospective review found 533 patients undergoing IA corticosteroid or IA NSAID injection for adhesive capsulitis between June 2015 and May 2020 at a single healthcare institution. Patient demographics characteristics, comorbidities, pain scores, and range of motion were compared. Treatment failure was defined as need for subsequent IA injection within 6 months or progression to surgical management within 12 months. 152 patients (28.52%) experienced treatment failure of IA corticosteroid injection. Pre-injection pain scores were greater for those who experienced treatment failure (5.40 vs. 4.21, p < 0.05). Post-injection pain scores were greater for those who experienced treatment failure (3.77 vs. 2.17, p < 0.01). Reduced post-injection external rotation in abduction also predicted treatment failure (56.88° vs. 70.22°, p < 0.01). IA corticosteroid injections are associated with increased rates of failure and progression to surgical management when patients present with increased pain levels as well as with less improvement in pain levels and ROM following injection.

Predictive Factors of Intra-articular Corticosteroid Injections with Ultrasound-Guided Posterior Capsule Approach for Patients with Primary Adhesive Capsulitis

“…Primary AC patients with diabetes could show less favorable response after intra-articular corticosteroid injection and physical therapy than subjects without diabetes. 16,17 Previous studies found that radiographic parameters such as the critical shoulder angle (CSA) and acromial index (AI), which were associated with increased opportunity of subacromial inflammation, can predict rotator cuff-related lesions. 18,19 We suppose that these radiographic parameters are associated with shoulder lesions caused by impingement and inflammation, which could result in a reduced response to anti-inflammatory treatment.…”

Allogenic Platelet-Rich Plasma for the Treatment of Adhesive Capsulitis

“…Adhesive capsulitis is associated with contracture of the joint capsule and the rotator interval, inclusive of the superior glenohumeral ligament and the coracohumeral ligament [4,5]. Frozen shoulder classically transitions through stages of "freezing" that may last up to 24 months [6]. While initially thought to be self-limiting, current studies suggest that a significant number of patients suffer from persistent, severe discomfort and loss of function [6].…”

“…Frozen shoulder classically transitions through stages of "freezing" that may last up to 24 months [6]. While initially thought to be self-limiting, current studies suggest that a significant number of patients suffer from persistent, severe discomfort and loss of function [6]. As AC leads to not only chronic pain but also restricted range of motion (ROM) of the glenohumeral joint in external rotation followed by abduction in the plane of scapula and flexion, the patient's activities of daily living (ADL) and overall QoL are adversely impacted [7,8].…”