Scope and Limitations in the Management of Patients with Frozen Shoulder

Abstract

Background: Frozen shoulder (adhesive capsulitis) is a disabling condition characterized by pain and restricted shoulder movement, commonly affecting middle-aged individuals. Treatment often includes physiotherapy, oral medications, and intra-articular corticosteroid injections, but their comparative effectiveness remains unclear, especially in low-resource settings.

Objective: To evaluate the scope and limitations in the management of frozen shoulder by comparing outcomes between conservative treatment and combination therapy involving corticosteroid injections in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.

Methods: This cross-sectional study was conducted from January to December 2020 and included 60 patients aged 20–65 years clinically diagnosed with frozen shoulder. Patients were divided into two groups: Group A received conventional medical treatment and physiotherapy, while Group B received the same plus a single dose of intra-articular corticosteroid (Triamcinolone 40 mg). Patients were assessed at baseline, 3 months, and 6 months using the Visual Analogue Scale (VAS) for pain and the Shoulder Pain and Disability Index (SPADI) for functional assessment. Relapse and dropout rates were also recorded.

Results: At 6 months, Group B showed significantly greater pain reduction (VAS 2.5 ± 1.1 vs. 3.9 ± 1.4) and improved functional scores (SPADI 35.3 ± 6.8 vs. 49.7 ± 9.1) compared to Group A (p < 0.05). Relapse and dropout rates were lower in Group B (6.7% and 6.7%, respectively) than in Group A (16.7% and 13.3%). Combination therapy demonstrated superior clinical effectiveness and better adherence.

Conclusion: Intra-articular corticosteroid injection combined with physiotherapy and medical treatment offers superior outcomes in pain relief and functional recovery compared to conservative therapy alone. Incorporating this approach in district-level hospitals may enhance the effectiveness of frozen shoulder management in low-resource settings.