Body mass index and active range of motion exercise treatment after intra-articular injection in adhesive capsulitis.

BACKGROUND: Adhesive capsulitis is commonly associated with medical diseases such as diabetes mellitus, hyperthyroidism, and obesity. Intra-articular injection has been used to speed recovery and relieve pain associated with frozen shoulder. In this study, we evaluated and compared the effects of an intra-articular injection of corticosteroid and lidocaine in the treatment of primary adhesive capsulitis in overweight and normal-weight patients.

METHODS: This is a prospective clinical study of patients with adhesive capsulitis, in which the main treatment strategy was an intra-articular injection of corticosteroid (3 mL) and lidocaine (3 mL). Active range of motion exercise was initiated immediately after the injection and performed four times daily. The evaluation included the recording of a detailed medical and orthopedic history, and the assessment of pain and function by determining the Constant score at baseline (before injection) and every 2 weeks thereafter. Patients were classified as normal weight (body mass index [BMI] < 25 kg/m(2)) or overweight (BMI ≥ 25 kg/m(2)). The Constant scores of all patients were compared at 8 weeks after injection.

RESULTS: After clinical examinations and radiographic and ultrasonographic studies, 79 patients were treated for adhesive capsulitis between 2010 and 2012. In the normal-weight group, the mean Constant score increased from 35.4 to 74.6 after 8 weeks, whereas in the overweight group, the mean Constant score increased from 32.0 to 47.2. There was a significant difference in the mean Constant score between the normal-weight and overweight groups at 8 weeks.

CONCLUSION: Active range of motion exercise after an intra-articular injection of corticosteroid and lidocaine improved pain and functional outcome at 8 weeks in normal-weight (BMI < 25 kg/m(2)) patients with primary adhesive capsulitis. Manipulation under anesthesia may be considered a priority in overweight patients.