Therapeutic efficacy of low-dose steroid combined with hyaluronidase in ultrasonography-guided intra-articular injections into 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, Seongnam Citizens Medical Center, Seongnam, Korea
3Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
4H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
Corresponding Author: Wonjae Lee ,Tel: +82-2-2225-1397, Fax: +82-2-2225-1391, Email:
Received: December 11, 2020;  Accepted: February 22, 2021.  Published online: February 22, 2021.
The purpose of this study was to compare the efficacy of low-dose steroid, highdose steroid, and low-dose steroid combined with hyaluronidase with respect to intra-articular injection therapy for adhesive capsulitis (AC) of the shoulder.
Thirty patients with primary AC in the initial stage were randomly assigned into three groups to receive ultrasound-guided intra-articular injections with 20 mg of triamcinolone acetonide (group A, n=10), 40 mg of triamcinolone acetonide (group B, n=10) and 20 mg of triamcinolone acetonide combined with hyaluronidase (group C, n=10). The outcome measures included a visual analogue scale (VAS), the 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.
Among the 30 patients, one participant in group B dropped out; therefore, 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 improved in all groups compared with the preinjection status, regardless of treatment or time point. In the comparison between groups, the SDQ and ISF showed significantly greater improvements in groups B and C than in group A.
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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