SAT0511 Management of Adhesive Capsulitis with Landmark Guided High Volume Steroid Injections in The Community Based Musculoskeletal Clinic
Authors: S. Baltsezak
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> Pathology of frozen shoulder (FS) includes inflammatory response with fibroblastic proliferation [1]. It results in global loss of motion due to rotator cuff interval and coraco-humeral ligament contracture as well as capsular thickening. Recently, image guided hydro-dilatation combined with steroid inj became popular FS management. Sometimes three injections with 2 week intervals are given [2]. This procedure is usually performed in outpatient radiology department and requires referral to secondary care. I present an audit of community based treatment of the frozen shoulder. All patients were treated during their 1st appointment at musculoskeletal clinic. I observed that patients respond well to landmark guided high volume steroid injection. It is quick to administer, does not require assistance or additional imaging. <h3>Objectives</h3> To assess whether landmark guided high volume steroid injections combined with home based unsupervised stretching exercises are effective in the treatment of frozen shoulder. <h3>Methods</h3> All patients diagnosed with Frozen shoulder during 1st appointment between September 2013 and August 2015 were included in the audit. They were followed up at 2–3 months. They were treated with high volume steroid injection: 1 ml 40 mg triamcinolone, 9 ml of 0.5% marcaine +/− normal saline. Standard posterior approach was used for glenohumeral joint injection. Four shoulder stretches were advised to patients for regular home unsupervised exercise. All patients had opportunity to access MSK service within 6 months from the 1st appointment. Their electronic record was reviewed again in January 2016 to establish whether they represented to our MSK service with the same problem. The primary end point of the study was the need for further secondary care orthopaedics referral. <h3>Results</h3> 90 patients were treated within the study period. 35.6% (32) of patients were male and 64.4% (58) were female. The mean age of the patients was 56.6 years. 54.4% of patient had duration of symptoms from 1–6 months, 37.8% of patient had duration of symptoms from 7–12 months, 6.7% had duration of symptoms from 13–18 months and 1.1% - 1 patient had symptoms for 24 months. 29 patients (32.2%) had ≥30ml of fluid injected in the glenohumeral joint (GHJ). 48 patients (53.3%) had 10 ml injected the GHJ. 10 patients (11.1%) had ≥20 ml injected in the GHJ. 3 patients (3.3%) had 15ml volume injection. 35 (38.8%) patients required more than 1 injection. Overall, during study period 3 (3.3%) patients required further orthopaedic management. 96.7% of patients were satisfied with the management and declined further orthopaedic referral during follow up appointment. <h3>Conclusions</h3> Landmark guided high volume steroid injections combined with stretching exercises are effective at relieving symptoms of frozen shoulder. This treatment can be recommended before considering further secondary care orthopaedics interventions. <h3>References</h3> Hand et al. The pathology of frozen shoulder. J Bone Joint Surg Jul 2007. Tveita et al. Hydrodilatation, corticosteroids and adhesive capsulitis: a randomised controlled trial. BMC Musculoskeletal disirders 2008. <h3>Disclosure of Interest</h3> None declared