Management for Primary Frozen Shoulder Associated with Night Pain An Effect of Steroid Injection

Abstract

Primary frozen shoulder is believed to be a self-limited disease. However, many patients complain of prolonged symptoms such as night pain and refractory stiffness. The purpose of this study is to estimate the efficacy of steroid injection to the glenohumeral joint for primary stiff shoulder associated with night pain. Subjects consisted of 115 consecutive patients, including 37 males and 72 females with an average age of 59.4 years old, who were diagnosed as having primary frozen shoulder at the shoulder clinic in our institute from May to November, 2009. Our treatment principles are as follows: we recommend patients who complain of night pain to keep their arm at rest and carry out trunk and scapular exercises, in addition to steroid injection to the glenohumeral joint once a week until the night pain subsides. Then, physiotherapy is initiated of the hand of therapists. Range of motion at the first visit and at the time when the night pain disappeared was evaluated, as well as that at the final follow-up which was 5.8 months on average.The mean forward flexion, external and internal rotation significantly improved when the night pain disappeared, which was 4.8 weeks on average, from 97.5, 9.2°, and S level to 117.5, 17.4°, and L4 level. The range of motion at the final follow-up was 144 degrees in flexion, 31 in external rotation, and L2 level in internal rotation.Steroid injection to the glenohumeral joint was effective for pain relief for patients with primary frozen shoulder associated with night pain. Removing inflammation at the glenohumeral joint is a key factor when treating such patients and this also enables patients to proceed with effective physiotherapy.