Short-term efficacy of ultrasound-guided capsule-preserving hydrodilatation for primary frozen shoulder using 5% dextrose water vs. corticosteroid: a randomized controlled trial.

Abstract

To compare the short-term efficacy of capsule-preserving hydrodilatation with 5% dextrose water (D5W) vs. glucocorticoids (GCs) for the treatment of primary frozen shoulder (PFS). A prospective randomized, controlled, noninferiority trial. In total, 84 patients with PFS were randomly divided into 2 groups: D5W group (patients in this group received ultrasound-guided capsule-preserving hydrodilatation with 20 mL of D5W) and GC group (patients in this group received ultrasound-guided capsule-preserving hydrodilatation with 1 mL of triamcinolone [40 mg] + 19 mL normal saline). All patients received 3 injections at 2-week intervals. The primary outcome was the Shoulder Pain and Disability Index (SPADI) score. The secondary outcomes were shoulder active range of motion (AROM) for forward flexion, abduction, extension, external rotation, and internal rotation and the numeric rating scale (NRS) score for shoulder pain intensity before injections and 1 day and 1, 4, 8, and 12 weeks after the first injection. Moreover, the proportion of patients consuming oral nonsteroidal anti-inflammatory drugs and patients' recovery satisfaction during the follow-up were recorded. SPADI, AROM, and NRS were significantly improved at each time point after treatment in both groups (P < .05). Repeated-measures analysis of variance revealed no significant differences in SPADI, AROM, NRS, and patients' recovery satisfaction between the 2 groups during the follow-up period (P > .05). However, the proportion of patients consuming oral nonsteroidal anti-inflammatory drugs was higher in the D5W group than in the GC group at 8 weeks after the first injection (P < .05). Ultrasound-guided capsule-preserving hydrodilatation with D5W and 40-mg triamcinolone yielded similar improvements in SPADI, AROM, and NRS scores at the 12-week follow-up as that with GCs. Considering the potential detrimental effects of GCs on the adjacent cartilage and tendons, we recommend D5W as an alternative therapy in patients with PFS in whom GCs may be contraindicated.