Tora Chase
CMP 315 Sec 1
Dr. Terryberry
September 26, 2014
A Single 20-mg Triamcinolone Injection Versus a Series of 3, 40-mg Triamcinolone Injections in the Treatment of Adhesive Capsulitis Adhesive capsulitis of the shoulder is a disorder that causes pain and restricts motion. Connective tissue around the glenohumeral joint becomes inflamed and stiff, which is the reason many call this disorder “frozen shoulder”. The source that causes adhesive capsulitis is unclear, but it is manageable and can be treated in various ways. Research shows that corticosteroid injections using triamcinolone is a safe and effective treatment option. Studies have been performed, testing separate amounts of injections as well as contrasting doses of triamcinolone on patients with adhesive capsulitis. The treatment evaluated by Lorbach et al2, uses 3 fluoroscopic-guided, intra-articular injections with 40-mg triamcinolone. The treatment evaluated by Juel et al1, uses one sonographic-guided, intra-articular injection with 20-mg triamcinolone. Based on the results provided by two articles, the series of fluoroscopic-guided, 40-mg triamcinolone injections would be preferred over the single injection of 20-mg triamcinolone. Lorbach et al demonstrates that the 40-mg triamcinolone treatment provides exceptional range of motion of the shoulder, significant decrease in pain, and improvement of patients’ mental health. In order for a treatment to be considered effective, the measured difference from the treatment’s beginning to 12 weeks must exceed the following: 50° abduction, 40° flexion, 24° external rotation, and 34 points shoulder pain. An acceptable treatment must also confirm that over 90% of participants were satisfied with their mental health. The preferred treatment involves 3 fluoroscopic-guided, 40-mg triamcinolone injections and two anesthetics: 5 ml bupivacaine and 5 ml mepivacaine.2 The average patients’ age of the study performed upon this treatment was 49. They were treated about 11 months after the beginning of their symptoms and received clinical evaluations at the start of treatment, and end of weeks 4, 8, and 12. Patients in this study were given an injection every 4 weeks and began physical therapy 4 weeks after their first injection. These patients were also advised to complete exercises in a pain-free range of motion. The sonographic-guided, 20-mg triamcinolone treatment also includes 3 ml lidocaine. Participants of this study had shoulder pain for 9 to 12 months before beginning treatment. The study included 34 participants that received injections parallel to the biceps tendon, while the patient was positioned supine.1 Medical practitioners performed practice sessions in order to obtain like techniques. Patients observed ranged between the ages of 45 and 70. A series of 3 40-mg triamcinolone injections is a sufficient choice when treating of adhesive capsulitis. Abduction and flexion were measured in both experiments using a marked canvas with 5° intervals. Lorbach et al2 claim that after 12 weeks, a 55° increase of abduction from the baseline of treatment was achieved. In the opposing article, 20-mg triamcinolone only achieved a 45° increase in active abduction and 33° increase in passive abduction from the baseline to the 12 week mark.1 Lorbach et al reached a 45° improvement of flexion, while Juel et al1 could only achieve a 37° flexion improvement with the single injection. Experiments performed on both treatments measured external rotation with the patients’ arms adducted and elbows 90° flexed. Lorbach et al estimate that external rotation of the average shoulder improved by 28° from the baseline after 12 weeks. Juel et al estimate that both active and passive external rotation improved by only 17° in that same time frame. Additionally, Lorbach et al collected data one year after the beginning of treatment. The average increase from the 12 week check-ups to the one year check-ups are as