Triamcinolone acetonide with arthroscopic capsular release for frozen shoulder promotes early recovery of shoulder abduction

Ryosuke Miyamoto; Hitoshi Shitara; Tsuyoshi Ichinose; Tsuyoshi Sasaki; Noritaka Hamano; Masataka Kamiyama; Kurumi Nakase; Hirotaka Chikuda

doi:10.1016/j.jseint.2022.12.022

Triamcinolone acetonide with arthroscopic capsular release for frozen shoulder promotes early recovery of shoulder abduction

JSES Int. 2023 Jan 21;7(3):406-411. doi: 10.1016/j.jseint.2022.12.022. eCollection 2023 May.

Authors

Ryosuke Miyamoto¹, Hitoshi Shitara¹, Tsuyoshi Ichinose¹, Tsuyoshi Sasaki¹, Noritaka Hamano¹, Masataka Kamiyama¹, Kurumi Nakase¹, Hirotaka Chikuda¹

Affiliation

¹ Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.

Abstract

Background: Current treatment options for frozen shoulder are not established as the standard-of-care. The condition may resolve without intervention, but symptoms may persist despite treatment. Frozen shoulder is associated with inflammatory reactions that can reduce quality of life. Our aim was to determine whether triamcinolone acetonide, an immunosuppressive steroid, improved functional recovery when administered after arthroscopic capsular release (ACR) for frozen shoulder.

Methods: We selected participants using inclusion and exclusion criteria designed to reduce the impact of potential confounding factors. Under general anesthesia, we performed ACR followed by manipulation to ensure adequate range of motion (ROM) and wound closure. In the steroid treatment group, we injected triamcinolone acetonide into the glenohumeral joint immediately prior to wound closure. The follow-up period was six months. To determine the efficacy of steroids in improving overall post procedure functional recovery we statistically analyzed data from various qualitative and quantitative variables.

Results: Our study consisted of 22 patients with frozen shoulder, 11 in each of the surgery-only and surgery with steroid injection groups. There were no significant differences between groups in the demographic data of the study participants. We observed significantly greater improvements in abduction ROM in the steroid treatment group than in the surgery-only group, at three and six months post treatment. Improvements in other movement parameters were similar in both groups. The steroid-treated group had a significantly higher numerical rating scale score for night pain at three months post treatment than the surgery-only group.

Conclusions: Postoperative steroid treatment led to early recovery of the abduction ROM in patients with frozen shoulder. Hence, the current standard-of-care protocol for frozen shoulder and other similar conditions requiring surgical intervention should include this type of treatment. Therapeutic reduction in the inflammatory response following ACR can significantly improve prognosis and quality of life.

Keywords: Adhesive capsulitis; Arthroscopic capsular release; Contracture; Frozen shoulder; Range of motion; Triamcinolone acetonide.