Therapeutic efficacy of low-dose steroid combined by hyaluronidase in ultrasonography-guided intra-articular injection in the shoulder for adhesive capsulitis
Jong-Hyuk Lee1, Eun Jung Choi2, Seok-Cheol Han1, Hee Sup Chung1, Mi Jung Kwon3, Prathap Jayaram4, Wonjae Lee1, Michael Y. Lee4
1Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
2Department of Rehabilitation Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
3Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Korea
4H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, United States
Corresponding Author: Wonjae Lee ,Tel: 01037489382, Fax: 0222251497, Email: braddom@nate.com
Received: December 11, 2020;  Accepted: February 22, 2021.  Published online: February 22, 2021.
ABSTRACT
Purpose:
The purpose of this study was to compare the efficacy of low-dose steroid, high-dose steroid, and low-dose steroid combined by hyaluronidase with respect to intra-articular injection therapy for the adhesive capsulitis (AC) of shoulder.
Methods:
Thirty patients with primary AC in the initial stage were randomly assigned into 3 groups to receive ultrasound-guided intra-articular injections with 20 mg (group A, n=10) and 40 mg triamcinolone acetonide (group B, n=10) and 20 mg triamcinolone acetonide combined with hyaluronidase (group C, n=10). The outcome measures included visual analogue scale (VAS), shoulder disability questionnaire (SDQ), abduction and external rotation range of motion, and intra-sheath fluid (ISF) before treatment and at 2, 4, 8, and 16 weeks after treatment.
Results:
Among these 30 patients, 1 subject of group B was dropped out, and so a total of 29 patients completed this study and were successfully injected. After the injection, the VAS, SDQ, range of flexion and external rotation, and ISF were improved in all groups compared with pre-injection, regardless of treatment or time-point. In the comparison between groups, the SDQ and ISF of groups B and C were improved significantly than those of group A.
Conclusion:
The therapeutic efficacy of combined low-dose corticosteroid and hyaluronidase is superior to that of low-dose corticosteroid and equivalent to that of high-dose corticosteroid in early AC
Keywords: Adhesive capsulitis; Intra-articular injections; Steroids; Hyaluronidase; Ultrasonography
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