High- vs Low-Dose Corticosteroid Injection in the Treatment of Adhesive Capsulitis with Severe Pain: A Randomized Controlled Double-Blind Study

Objective. To compare the degree of pain relief between high-dose (40mg of triamcinolone acetonide) and low-dose (20mg of triamcinolone acetonide) corticosteroid injections in patients with severe pain due to adhesive capsulitis. Design. A prospective, randomized, double-blind, dose-comparative study. Subjects. A total of 32 patients who were diagnosed with adhesive capsulitis and who expressed severe pain intensity, 8 or more points on a numeric rating scale (NRS). Methods. Patients received injections of high-or low-dose triamcinolone acetonide under ultrasound guidance. NRS, Shoulder Pain and Disability Index (SPADI), and the passive range of motion (PROM) in four directions were evaluated before and three weeks after the injection. Results. NRS scores showed significant improvement three weeks after the injection in both groups (P=0.01 in both the low-dose group and high-dose group), but there was no statistically significant difference between the two groups (P=0.63). SPADI score significantly improved at three weeks after the injection in both groups (P=0.02 in the low-dose group and P<0.01 in the high-dose group), but group difference was not observed (P=0.06). The change of PROM in four directions after the injection did not show any significant difference between the low-and high-dose groups. Conclusions. Injection of 20mg of triamcinolone acetonide is sufficient to elicit symptom relief in patients with severe adhesive capsulitis; hence, 20mg of triamcinolone acetonide can be recommended in patients with adhesive capsulitis with severe pain.