Abstract:
BACKGROUND:Optimal management for adhesive shoulder capsulitis (frozen shoulder) is currently unclear. We intended to explore whether treatment by intra-articular injections with corticosteroid and distension is more effective than treating with corticosteroids alone or treatment-as-usual in a primary care setting in Norway. METHODS:In this prospective randomised intention to treat parallel study, 106 patients were block randomised to three groups; 36 (analysed 35) receiving steroid injection and Lidocaine (IS), 34 receiving steroid and additional saline as distension (ISD) and 36 had treatment-as-usual (TAU). Intervention groups received four injections within 8 weeks, assessed on 1st visit, at the 4th and 8th week. Outcomes were Shoulder Pain and Disability Index (SPADI), Numerical pain rating scale (NPRS) and passive range of motion (PROM). Postal assessment was repeated after 1 year for SPADI. Patients in the IS and ISD groups were "blinded" for intervention received and the assessor was "blinded" to group allocation. RESULTS:At baseline there were no differences between groups in outcome measures. There were no statistical significant differences between the intervention groups in SPADI, NPRS and PROM at baseline, at short-term (4-and 8 weeks) or long-term (12 months). There were statistically significant differences (p < 0.01) in change scores at short-term for SPADI when comparing the IS and TAU groups (-20.8; CI-28.9 to -12.7), and the ISD and TAU groups (-21.7; CI-29.4 to -14.0), respectively for NPRS (-2.0; CI-2.8 to -1.1 and -2.2; CI-3.0 to -1.4), and for PROM, but not at long-term for SPADI (p > 0.05). Effect size (ES) at 8 weeks was large between both injection groups and TAU (ES 1.2). At 12 months ES was reduced to 0.3 and 0.4 respectively. Transitory side effects as flushing and after-pain were reported by 14 % in intervention groups. CONCLUSION:This intention to treat RCT in primary care indicates that four injections with corticosteroid with or without distension, given with increasing intervals during 8 weeks, were better than treatment-as-usual in treatment of adhesive shoulder capsulitis. However, in the long run no difference was found between any of the groups, indicating that natural healing takes place independent of treatment or not. TRIAL REGISTRATION:ClinicalTrials.gov, https://clinicaltrials.gov/ identifier: NCT01570985.
journal_name
BMC Musculoskelet Disordjournal_title
BMC musculoskeletal disordersauthors
Sharma SP,Bærheim A,Moe-Nilssen R,Kvåle Adoi
10.1186/s12891-016-1081-0subject
Has Abstractpub_date
2016-05-26 00:00:00pages
232issn
1471-2474pii
10.1186/s12891-016-1081-0journal_volume
17pub_type
杂志文章,随机对照试验abstract:BACKGROUND:To identify the optimal viewing angles for every proximal screw in PHILOS plate-fixed proximal humeral fractures. METHODS:Three fresh-frozen human cadaveric bodies with six intact shoulders were studied. All three bodies were put in the beach chair position and PHILOS plates were placed on the proximal hume...
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journal_title:BMC musculoskeletal disorders
pub_type: 杂志文章,多中心研究
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pub_type: 临床试验,杂志文章
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