EXTENDED REPORT

Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial

R Buchbinder¹, J L Hoving¹, S Green², S Hall³, A Forbes⁴, P Nash⁵

¹ Monash Department of Clinical Epidemiology, Cabrini Hospital and Monash University Department of Epidemiology and Preventive Medicine, Melbourne, Australia
² Australasian Cochrane Centre, Monash Institute of Health Services Research, Melbourne
³ Department of Medicine, Monash University
⁴ Department of Epidemiology and Preventive Medicine, Monash University
⁵ Rheumatology Research Unit, Nambour, Queensland, Australia

Correspondence to:
Correspondence to:
Associate Professor R Buchbinder
Department of Clinical Epidemiology, Suite 41 Cabrini Medical Centre, 183 Wattletree Rd, Malvern, Victoria, Australia 3144; rachelle.buchbinder{at}med.monash.edu.au

Objective: To determine whether a short course of prednisolone is superior to placebo for improving pain, function, and range of motion in adhesive capsulitis.

Design: Double blind, randomised, placebo controlled trial.

Setting: Community based rheumatology practice in Australia.

Participants: 50 participants (24 active, 26 placebo); 46 completed the 12 week protocol. Entry criteria were age 18 years, pain and stiffness in predominantly one shoulder for 3 weeks, and restriction of passive motion by >30° in two or more planes.

Interventions: 30 mg oral prednisolone/day for three weeks or placebo.

Main outcome measures: Overall, night, and activity related pain, SPADI, Croft shoulder disability questionnaire, DASH, HAQ, SF-36, participant rated improvement, and range of active motion measured at baseline and at 3, 6, and 12 weeks.

Results: At 3 weeks, there was greater improvement in overall pain in the prednisolone group than in the placebo group (mean (SD) change from baseline, 4.1 (2.3) v 1.4 (2.3); adjusted difference in mean change between the two groups, 2.4 (95% CI, 1.1 to 3.8)). There was also greater improvement in disability, range of active motion, and participant rated improvement (marked or moderate overall improvement in 22/23 v 11/23; RR = 2 (1.3 to 3.1), p = 0.001). At 6 weeks the analysis favoured the prednisolone group for most outcomes but none of the differences was significant. At 12 weeks, the analysis tended to favour the placebo group.

Conclusions: A three week course of 30 mg prednisolone daily is of significant short term benefit in adhesive capsulitis but benefits are not maintained beyond six weeks.

Abbreviations: DASH, disabilities arm shoulder and hand; HAQ, health assessment questionnaire; SF-36, short form 36 item health survey; SPADI, shoulder pain and disability index

Keywords: adhesive capsulitis; frozen shoulder; prednisolone

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