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Comparative Effectiveness of Corticosteroid Dosages for Ultrasound-Guided Glenohumeral Joint Hydrodilatation in Adhesive Capsulitis: A Randomized Controlled Trial

  • Jia-Chi Wang
    Affiliations
    Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan

    School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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  • Po-Cheng Hsu
    Affiliations
    Department of Physical Medicine and Rehabilitation, West Garden Hospital, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan
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  • Kevin A. Wang
    Affiliations
    Division of General Surgery, Department of Surgery, Shin-Kong Memorial Hospital, Taipei, Taiwan

    School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
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  • Wei-Ting Wu
    Affiliations
    Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan
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  • Ke-Vin Chang
    Correspondence
    Corresponding author Ke-Vin Chang, MD, PhD, Department of Physical Medicine and Rehabilitation, National Taiwan University, Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan.
    Affiliations
    Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan

    Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Published:December 12, 2022DOI:https://doi.org/10.1016/j.apmr.2022.11.007

      Abstract

      Objective

      To investigate the efficacy of hydrodilatation with 40 mg triamcinolone acetonide (TA) compared with the same procedure with 10 mg TA in patients with adhesive capsulitis (AC) of the shoulders.

      Design

      Prospective, double-blind, randomized controlled trial with 12 weeks of follow-up.

      Setting

      Tertiary care rehabilitation center.

      Participants

      Eighty-four patients diagnosed with AC (N=84).

      Interventions

      Ultrasound guidance using (A) hydrodilatation with 4 mL of TA (40 mg)+4 mL 2% lidocaine hydrochloride+12 mL normal saline or (B) hydrodilatation with 1 mL of TA (10 mg)+4 mL 2% lidocaine hydrochloride+15 mL normal saline through the posterior glenohumeral recess.

      Main Outcome Measures

      Shoulder Pain and Disability Index (SPADI), visual analog scale (VAS) for pain, and range of motion (ROM) at baseline and at 6 and 12 weeks after injection.

      Results

      Both groups experienced improvements in the SPADI score, VAS scores for pain, and ROM throughout the study period. However, group-by-time interactions were not significant for any outcome measurement at any follow-up time point. No adverse events were reported in either group.

      Conclusion

      Ultrasound-guided hydrodilatation with 40 and 10 mg TA yielded similar improvements in SPADI, VAS score, and ROM at the 12-week follow-up. Considering the potential detrimental effects of corticosteroids on the adjacent cartilage and tendons, a low dose of TA would be preferable for ultrasound-guided hydrodilatation for AC.

      Keywords

      List of abbreviations:

      AC (adhesive capsulitis), ROM (range of motion), SPADI (Shoulder Pain and Disability Index), TA (triamcinolone acetonide), VAS (visual analog scale)
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