ORIGINAL ARTICLE 717 P J M H S Vol. 8, NO. 3, JUL – SEP 2014 Efficacy of Intra-Articular Steroid Injection in the Management of Primary Frozen Shoulder MUDASSAR SIDDIQUE, M SAEED AKHTAR*, NOMAN SHAKEEL NIAZI, ADNAN LATIF MALIK, HASSAN ALI, SUHAIL NIAZ KHAN NIAZI ABSTRACT Aim: To assess the efficacy of Intra-articular steroid injections for the management of Primary Frozen Shoulder. Method: 100 patients were selected from orthopedic OPD of Lahore General Hospital, Lahore. University of California Los-Angeles (UCLA) score was measured at 3 rd , 6 th and 12 th week after treatment to determine the efficacy of intra articular steroid Injection as compared to pre treatment/ at the time of base line UCLA score. Results: in our study 63% were males and 37% were female there mean age was 45.78±9.79years. At the time of base line the average UCLA score was 12.21±3.25, on the 1 st visit it increased to 20.4±5.35 and on the final visit the average UCLA Score was 30.31±4.30, 82% patient’s score were between the good-excellent ranges. UCLA Score of at each visit it was found statistically significantly higher than the score of previous visit (p-value <0.001). Conclusion: intra-articular steroid injection is an effective treatment for the management of the primary frozen shoulder. We recommend this treatment as it is not only safe and cost effective but, also as effective as manipulation under anesthesia. Keywords: Primary Frozen Shoulder, Intra-articular Steroid Injection, Efficacy, ULCA score INTRODUCTION Adhesive capsulitis, commonly known as frozen shoulder 1 , is characterized by inflammation of synovial lining and articular shoulder capsule, leading to pain, stiffness and restricted mobility 2 . Frozen shoulders are divided into two groups; primary i.e., patients with Idiopathic (unknown cause) frozen shoulder and secondary i.e., patients with frozen shoulder due to trauma, inflammatory disorder or medical condition like diabetes. 3 Reported incidence of frozen shoulder in general population ranges from 3-5% but, in diabetic patients the incidence was as high as 20% 4 . Usually patients report one shoulder but it’s evident that one in five adhesive capsulitis effects both shoulder 2 . Many treatments are suggested by orthopaedic professionals to the patients of Frozen Shoulder Syndrome (FSS). Some suggest different non- operative treatments like physical therapy, exercises, articular stretching and pulley therapy and some suggest physical therapy with medication. 5 Intensive physical therapies including passive stretching and manual mobilization have shown average results 6 . Similarly, low oral corticosteroid has potential hyperglycemic effect 7 . But, the combination of ----------------------------------------------------------------------- Department of Othopaedic, Lahore General Hospital, Lahore *Department of Othopaedic, Jinnah Hospital, Lahore Correspondence to Dr. Mudassar Siddique, Senior Registrar Email: mudassarsaddique75@yahoo.com physical therapy and medication have shown better results. In a recent study a Chinese researcher reveals that using acupuncture and physical treatment has better result than single treatment for the remedy of frozen shoulder 8 . Surgical techniques like manipulation, distention arthrography and open surgical release have also been reported successful in treating frozen shoulder. But due to invasive and anesthetic procedure these techniques are avoided. Hazel man noted that patients, who received steroid injection with physical therapy, have shown better results than the ones treated with manipulation of the glenohumeral joint 9 . In a study, Non Steroidal Anti Inflammatory Drugs (NSAIDs) and Local Glucocorticoid injections were given to diabetic patients with frozen shoulder. After 12 weeks follow up both were found effective in diabetic patients in term of range of motion (ROM) and remedy of pain. No significant difference was present in diabetic patients. In the previous studies controversial results were found. In this study we have tried to find the efficacy of intra articular steroid in management of primary frozen shoulder. MATERIAL AND METHODS It was an observational, follow up study. 100 cases were selected from Outpatient Department of Orthopedics, PGMI/Lahore General Hospital, who