Frozen Shoulder and Pain Management Role of Injectable steroid Therapy
Adhesive capsulitis is commonly known as Frozen shoulder. A condition of unknown cause that commonly presents with severe pain, limitation of range of motion and extreme functional disability of the affected shoulder joint.
It affects up to 5% of the general and 20% in the diabetic population.
It is a condition that progresses through 3 stages, pain dominant to stiffness dominant and lasting up to 12 months followed by spontaneous recovery of pain with severe residual shoulder disability.
While spontaneous recovery may take more than a year, the primary focus of treatment is to control the pain and restore the joint movements at the earliest. As it progressively disturbs your sleep and joint functions and makes you disable to perform your activity of daily livings.
With that being said, Pain management and supervised Physiotherapy are the cornerstones of treatment of Frozen Shoulder at any point in time. Occasionally, the patient finds difficult to do rehabilitation exercises due to extreme pain or due to fear of pain.
Injectable steroid therapy is one of the most effective musculoskeletal pain management approaches. For individuals with Frozen shoulders, local injectable steroids in the joint significantly help in pain control and early recovery.
The following are the few frequently asked questions regarding the use and safety.
What is injected inside my joint and what does it do?
Steroid injections act as powerful anti-inflammatory medicine that is injected directly into the shoulder joint. They are also used as hydro-dilators to expand and stretch the shoulder joint capsule with an anti-inflammatory effect. The injection typically involves a combination of corticosteroids with a local anesthetic.
How does steroid injection reduce pain?
Anti-inflammatory action of steroid, reduce the local inflammation or swelling in and around the joints, thereby alleviating pain. In cases of frozen shoulder, large volume injections can be performed to distend the capsule which in turn reduce the pain.
What are the Risks?
Any invasive procedure will have a certain amount of risk associated with it, the risk of septic arthritis from intra-articular corticosteroid injections is less than 0.03%.
What if I have Diabetes?
For Diabetic patients, the risk of hyperglycemia is almost transient and negligible when undergoing intra-articular joint injections.
Is there a benefit doing under Ultrasound guidance?
Most of the blinded injections yield a sub-optimal response; hence it is beneficial to use ultrasound guidance for accuracy.
Musculoskeletal injections are safe and comfortable with the use of the proper technique.
What is the required dose for my condition?
The dose of steroid injection depends on the reason for a steroid injection. The common practice is to inject 40 mg of long-acting steroid injection for most of the indications which are proven to be helpful.
How soon can I begin/resume Physiotherapy?
To restore joint mobility and functionality, physiotherapy & exercises must be resumed as early as possible after 24 or 48 hours of injection, as few patients may experience pain at the injection site.
Dr. Atwar Hussain,
M.B.B.S, MSc. SEM (UK) ,Dip. SEM(IOC), Dip. SEM (FIFA).
Sports and Exercise Physician
YOS Sports Health Specialists, Bangalore