Aims: There is no consensus on the use of intra-articular corticosteroid injections in diabetic frozen shoulder (FS). Thus, we aimed to compare clinical outcomes after intra-articular corticosteroid injections in patients with diabetic FS and idiopathic FS.
Methods: We retrospectively reviewed prospectively collected data of 445 consecutive patients with FS who received intra-articular corticosteroid injections in the glenohumeral joint under a single physiatrist from March 1, 2014 until July 31, 2017. In total, 132 patients received intra-articular corticosteroid injection because of secondary frozen shoulders, such as rotator cuff-related stiffness, osteoarthritis, or rheumatic diseases, and were excluded from the study. Twenty-six patients with bilateral involvement were excluded, and 145 patients were subsequently excluded due to the lack of follow-up data. The remaining 142 patients with the diagnosis of FS were dichotomized into idiopathic FS group and diabetic FS group. Thirty-two patients were diagnosed with diabetic FS and 110 patients with idiopathic FS. Data including visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value (SSV), and passive range of motion (ROM) were compared before the injection and at 3, 6, and 12 weeks after the injection.
Results: There were significant improvements in all outcomes (p < 0.001 for all parameters) through 12 weeks in both groups (Fig. 1 and 2). There were no significant differences in all outcomes, except for ASES scores, between both groups at 3 weeks. However, there were significant differences in VAS score, SSVs, ASES scores, and passive ROMs, except for angle of abduction, between the two groups at 6 weeks and 12 weeks after injection (Fig. 1 and 2).
Conclusion: A single intra-articular steroid injection can be used as a conservative treatment for diabetic FS, but its effect is less than that in idiopathic FS.
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Fig. 1. Comparison of range of motion between the two groups. Internal rotation was recorded on the basis of the vertebral level reached with the tip of the thumb. Asterisk indicates significant differences between the idiopathic frozen shoulder group and the diabetic frozen shoulder group at each time point. Error bar means one standard deviation.
Fig. 2. Comparison of functional scores (VAS, ASES score, SSV) between the two groups. Asterisk indicates significant differences between the idiopathic frozen shoulder group and the diabetic frozen shoulder group at each time point. VAS, visual analog scale; ASES, American Shoulder and Elbow Surgeon score; SSV, subjective shoulder value. Error bar means one standard deviation.
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