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Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial
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  1. R Buchbinder1,
  2. J L Hoving1,
  3. S Green2,
  4. S Hall3,
  5. A Forbes4,
  6. P Nash5
  1. 1Monash Department of Clinical Epidemiology, Cabrini Hospital and Monash University Department of Epidemiology and Preventive Medicine, Melbourne, Australia
  2. 2Australasian Cochrane Centre, Monash Institute of Health Services Research, Melbourne
  3. 3Department of Medicine, Monash University
  4. 4Department of Epidemiology and Preventive Medicine, Monash University
  5. 5Rheumatology Research Unit, Nambour, Queensland, Australia
  1. Correspondence to:
    Associate Professor R Buchbinder
    Department of Clinical Epidemiology, Suite 41 Cabrini Medical Centre, 183 Wattletree Rd, Malvern, Victoria, Australia 3144; rachelle.buchbindermed.monash.edu.au

Abstract

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.

  • DASH, disabilities arm shoulder and hand
  • HAQ, health assessment questionnaire
  • SF-36, short form 36 item health survey
  • SPADI, shoulder pain and disability index
  • adhesive capsulitis
  • frozen shoulder
  • prednisolone

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