Efficacies of corticosteroid injection at different sites of the shoulder for the treatment of adhesive capsulitis
A corticosteroid injection in the glenohumeral joint conducted blindly is technically demanding with a low rate of accuracy despite satisfactory clinical outcomes in the treatment for adhesive capsulitis. This study prospectively compared the clinical outcomes of patients with idiopathic adhesive capsulitis treated by a single corticosteroid injection in different locations of the shoulder.
Materials and methods
We randomly assigned 191 patients with adhesive capsulitis to 1 of 4 groups based on corticosteroid injection location: group I, subacromial; group II, intra-articular; group III, intra-articular combined with subacromial space; and group IV, medication. Pain relief and patient satisfaction were assessed with a visual analog scale and functional outcomes were evaluated with the American Shoulder and Elbow Surgeons score up to 24 weeks after treatment.
Patients treated with corticosteroids achieved faster pain relief and had greater satisfaction levels than patients in group IV during the 16 weeks after treatment. However, no significant difference in pain scores was observed among the 4 groups at 24-week follow-up visits (P = .670). Shoulder motion and function improved in all groups at final follow-up. However, shoulder motion in the injection groups recovered faster than that in group IV. At 24 weeks after treatment, no significant differences in shoulder motion or functional outcomes were found among the 4 groups (P = .117).
The efficacy of a single corticosteroid injection was not found to be related to the site of injection. However, a single corticosteroid injection provided faster pain relief, a higher level of patient satisfaction, and an earlier improvement in shoulder motion and function than medication in patients with adhesive capsulitis.
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ABSTRACT: Abstract Inhibition of the extracellular process of collagen fibril formation represents a new approach to limiting posttraumatic or postsurgical localized fibrosis. It has been demonstrated that employing a monoclonal antibody that targets the C-terminal telopeptide of the α2 chain of collagen I blocks critical collagen I-collagen I interaction, thereby reducing the amount of collagen deposits in vitro and in animal models. Here, we developed a chimeric variant of a prototypic inhibitory antibody of mouse origin. The structure of this novel antibody was analyzed by biochemical and biophysical methods. Moreover, detailed biochemical and biological studies were employed to test its antigen-binding characteristics. The ability of the chimeric variant to block formation of collagen fibrils was tested in vitro and in high-density cultures representing fibrotic processes occurring in the skin, tendon, joint capsule, and gingiva. The potential toxicity of the novel chimeric antibody was analyzed through its impact on the viability and proliferation of various cells and by testing its tissue cross-reactivity in sets of arrays of human and mouse tissues. Results of the presented studies indicate that engineered antibody-based blocker of localized fibrosis is characterized by the following: (1) a correct IgG-like structure, (2) high affinity and high specificity for a defined epitope, (3) a great potential to limit the accumulation of collagen-rich deposits, and (4) a lack of cytotoxicity and nonspecific tissue reactivity. Together, the presented study shows the great potential of the novel chimeric antibody to limit localized fibrosis, thereby setting ground for critical preclinical tests in a relevant animal model.Connective tissue research 04/2013; DOI:10.3109/03008207.2013.778839 · 1.98 Impact Factor
- Annals of internal medicine 09/2013; 159(6):JC6. DOI:10.7326/0003-4819-159-6-201309170-02006 · 16.10 Impact Factor
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ABSTRACT: Objective: To compare the treatment efficacy between corticosteroid injection and nonsteroidal anti-inflammatory drugs (NSAIDs) for patients with shoulder pain. Data Sources: PubMed and EMBASE databases were searched from inception to January 2014. Reference lists of the retrieved studies were additionally scrutinized. Study Selection: Randomized controlled trials (RCTs) comparing corticosteroid injection with NSAIDs for treatment of shoulder pain were included. The primary outcome was remission, and the secondary outcomes were pain relief and improvement of range of active abduction. Study selection was conducted by 2 researchers independently. Any disagreements were solved by discussion and confirmed by the third reviewer. Data Extraction: Two reviewers independently conducted data extraction and the quality assessment. Data regarding patients, intervention, control, and outcomes were extracted from the included trials. Data Synthesis: Six high-quality RCTs of 267 patients meeting the inclusion criteria were included. For an outcome of remission, NSAIDs were less effective than corticosteroid in 4 or 6 weeks (relative risk, .64; 95% confidence interval,.45-.92). NSAIDs did not significantly differ with corticosteroid in pain relief and improvement of range of active abduction. Conclusions: Current meta-analysis suggests that NSAEDs are less effective than corticosteroid in achieving remission in patients with shoulder pain at 4 or 6 weeks after treatment. Considering the limited number of studies and small size of each trial, the results should be interpreted with caution, and more high-quality RCTs are encouraged. (C) 2014 by the American Congress of Rehabilitation MedicineArchives of Physical Medicine and Rehabilitation 05/2014; 95(10). DOI:10.1016/j.apmr.2014.04.024 · 2.44 Impact Factor