Introduction - Analyzing Corticosteroid Effectiveness on Frozen Shoulder
Frozen shoulder is a common type of arm injury that has been characterised by restriction and pain. The treatment of this shoulder disorder has included different neurosurgical treatments however comparative efficacy has not been clinically analysed. Therefore, this essay has critically analysed the extinct of corticosteroid injections regarding pain relief for frozen shoulders. In this regard, the overall critical analysis of current literature, and synthesis of evidence have been critically evaluated here. On the basis of the literature investigation and evidence, a set of opportunities regarding discussion with the team on this topic has been developed by the analysis. In addition, on the basis of current best practices of frozen shoulder treatment, a new set of skills has been developed.
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Critical analysis of corticosteroid injections in relieving pain in frozen shoulder patients
Corticosteroid injections have been effective in proving short-term relief for frozen shoulders by improving arm function and reducing pain.
Figure 1: Frozen shoulder disorder
Frozen shoulder is a most common shoulder injury that resulted in the thickened and fibrosis of the joint capsules, reduction of intra-articular volume and contraction of the shoulder joint (Altonpainclinic.co.uk, 2023). Generally, the major cause behind shoulder freezing has been identified due to an arm fracture as well as surgery and keeping the arm still for a long time during the recovery process.
Investigation of current literature
According to Karbowiak et al. (2022), people with diabetes have possessing a higher risk of developing frozen shoulders along with bilateral symptoms as compared to the general population. In contradiction, Silvestri et al. (2022) identified that people with hyperthyroidism have greater chances to be affected by frozen shoulders due to the ineffectiveness of physical activities. Acceding to Zhang et al. (2021), extracorporeal shockwave and capsular distension therapies have been effective in the reduction of pain and improvements of function in frozen shoulders. The author has used network meta-analysis and systematic literature review to identify the effectiveness of Capsular distension therapies in frozen shoulder. However, Song, Song & Li (2021) has identified that the combination of an intra-articular steroid injection (ISI) and Manipulation under anaesthesia (MUA) has been effective in the relief of pain for patient with frozen shoulders. The retrospective cohort study of the author has resulted that intra-articular steroid injections (ISI) such as Corticosteroid injections are helpful in the reduction of disability and pain of a frozen shoulder by improving the painful freezing stages of the shoulder. This results in the relief of the pain of a frozen shoulder through a process of passive tearing of frozen shoulder capsular adhesion.
As stated by Millar et al. (2022), a frozen shoulder has been characterised by fibrosis of the fibroproliferative tissue that has produced Type 1 and Type 3 collagen that is further transformed into myofibroblasts. This has resulted in the development of capsular fibrotic contractures in the shoulder possessing clinical stiffness and contractures. According to Dai et al. (2022), a combination of corticosteroid hydrodilatation along with arthroscopic release has given better results regarding the passive range of rotation to frozen shoulders and relief’s pain. The author has utilised a randomized clinical trial of 72 patients with frozen shoulders to identify the effectiveness of corticosteroid hydrodilatation for frozen shoulder treatment. In contradiction, Rae et al. (2022) have stated that hydrodistension and physiotherapy are two effective approaches regarding the reduction of pain in frozen should in case of failure of standard treatment. The observational study of 90 patients has indicated that physiotherapy can also reduce pain for patients having frozen shoulders. The activation of glucocorticoid receptors and inhibition of the function in the intra-articular steroid injection (ISI) process of inflammatory mediators has decreased peri-articular fibrosis and synovitis (Song, Song & Li, 2021). This also helped in pain relief for patients having frozen shoulders.
Figure 3: Frozen shoulder developed from Parkinson’s disease
According to Papalia et al. (2019), the presence of impairment of posture in Parkinson's disease has resulted in the increase of thoracic kyphosis and also decreases in the mobility of the trunk. This resulted in the inflammation of shoulder pain, reduction of movement and further developed frozen shoulder symptoms. Therefore, improvements in mobility and functions of the frozen shoulders can help in relieving pain. According to Song, Song & Li (2021), Manipulation under anesthesia (MUA) has been an effective approach to minimise the pain of a frozen shoulder. In contradiction, the randomised trial of Rangan et al. (2020) has stated that “Manipulation under anesthesia (MUA)” and “arthroscopic capsular release” are not effective treatments for frozen shoulders due to uncertainty in effectiveness and cost factors.
According to Razmjou (2022), the presence of co-morbidities, rheumatological, endocrinological and autoimmune conditions has increased the chances of frozen shoulders. The author has stated that a frozen shoulder can be considered as the secondary symptom of severe diseases such as septic arthritis as well as a malignant tumour. These factors have subsequently increased the risk factor of shoulder freezing due to the ineffectiveness and physical activities of the patients. In contradiction, Sundararajan et al. (2022) have identified that the Arthroscopic capsular release (ACR) approach in frozen shoulder pain relief has provided lesser improvements to diabetic patients with the frozen shoulder as compared to nondiabetic patients. The author has implemented a randomised trial for the analysis of the effectiveness of Arthroscopic capsular release (ACR) in frozen shoulder treatment. However, the author has sate that Manipulation under anaesthesia (MUA) has been effective treatment approach for pain relief in Frozen shoulders that ACR due to its cost-effectiveness.
Critical review and synthesis of evidence
Figure 4: Corticosteroid injections in frozen shoulder
The anti-inflammatory nature of corticosteroid injections has been effective in the reduction of pain associated with the patient having a shoulder frozen by injecting the injection between the Subacromial space and the shoulder (Cambridgeshoulder.co.uk, 2023). As suggested by Lee et al. (2022), the effectiveness of Corticosteroid Injection along with Hydrodilatation has been effective for patients with frozen shoulders as the overall range of motion, pain and disability score have been improved. Improvements in pain, disability as well as a range of motion have been considered evidence of the effectiveness of treatment for frozen shoulders. A progressive loss regarding the movement of the shoulder and massive pain has been characterised as the key symptoms of frozen shoulder pains. The diagnosis of this shoulder disorder has included a physical examination that is further based on the stages of a frozen shoulder. A frozen shoulder disorder has included three main stages “The painful/Freezing Stage”, “Frozen Stage” and the “Thawing Stage” (Cambridgeshoulder.co.uk, 2023). However, the overall disease management and treatment has included different therapies and approaches such as physiotherapy, hydrodilation and surgical intervention, corticosteroid injections, Manipulation under anesthesia (MUA), Arthroscopic capsular release (ACR), Platelet-Rich Plasma Injection, and others.
As opined by Date & Rahman (2020), physical treatment for frozen shoulder has been effectively treated by using physiotherapy that includes electrical nerve stimulation, steroid injections, analgesics and warm or cold pads. However, the author has further stated that the physical therapies regarding frozen treatment have been considered different due to the physical examination of the shoulder and the disorder stages. For instance, in the early freezing stages for should freeze, patients have been recommended to take approaches of stretching exercises. In the thawing stages, a combination of strengthening and stretching exercises has been recommended that has been enhancing the rotation of motion and helped in relieving pain. As suggested by Song, Song & Li (2021), intra-articular steroid injection (ISI) has been effective in the reduction of frozen shoulder pain. The author has performed a retrospective cohort study among 141 patients to analyse the effectiveness of the combination of Manipulation under anesthesia (MUA) and intra-articular steroid injection (ISI). The findings of the results show that the overall improvements of range of motion and pain have been improved by the patients with frozen shoulders within the 2 weeks after the intervention of the combined therapies.
As stated by Cho et al. (2021), the application of corticosteroid injections between the shoulder joints has been effective in improvements of shoulder mobility and reducing overall pain. The author has implemented a randomized trial among 90 patients having a primary level of frozen shoulder to analyse the effectiveness of corticosteroid injections in shoulder pain relief. The results of this study show that infection of sterile water into the shoulder joint capsule has helped in stretching the tissues that further ensures the effective movements of the joint. This further helped in reducing the pain and improving the shoulder movements. In contradiction, Chen, Jiang & Huang (2019) have stated that the anti-inflammatory properties of corticosteroid injections further helped in reducing pain and inflation of should joint for patients having frozen shoulders. The author has also stated that Intra-articular injections such as corticosteroid injections are effective in pain relief for frozen shoulder patients as compared to subacromial injections and this has not possessed any types of adverse effects on the body. As suggested by Lee et al. (2022), significant changes in the rotation of rotation for the shoulder joints as well as the disability and pain of a frozen shoulder have been improved and treated by using corticosteroid injections within 2 to 4 weeks. This treatment usually helped in the treatment of frozen shoulder pain within some weeks to 3 months.
Opportunities for discussion with the team
During this assessment, I have gained different knowledge regarding the treatment of a frozen shoulder that further requires a wide discussion with the team for skills development. During this study, I have identified the root cause of frozen shoulders and the associated disease that can cause this arm injury. In this regard, the overall treatment of frozen shoulder has also been analysed as that indicating that lack of proper treatment causes the primary disease from this disorder such as a malignant tumour, arthritis and others. In my opinion, further discussion of this topic has been created for the team members regarding the proper analysis of frozen shoulder treatment with effectiveness and cost-efficient manner. In addition, further discussion with collaboration can increase the overall skills regarding the treatment of frozen shoulder patients effectively by analysing the effectiveness of corticosteroid injections.
Incorporation of current best practices into the skill set
During the research, I analysed a wide range of current best practices regarding the treatment of frozen shoulder disorder. These current best practices include physiotherapy, corticosteroid injections, Manipulation under anesthesia (MUA), Arthroscopic capsular release (ACR), hydrodilation and surgical intervention and others. I have investigated that, corticosteroid injection approaches of frozen shoulder treatment have been effective to reduce the pain and inflation of the shoulder joints without any types of side effects. In addition, Manipulation under anesthesia (MUA) treatment has also been effective in pain reduction. Therefore, the skills regarding proper incorporation for treatment at specific times based on the stages of a frozen shoulder can help me to manage patients effectively in the future.
Conclusion
In conclusion, it can be stated that corticosteroid injection has been an effective and evidence-based approach to reducing pain for patients having shoulder frozen disorder. This has provided short-term relief regarding pain during frozen shoulders as well as considered a long-term treatment due to its efficiency and inflammatory properties. Arm fracture, surgery, and recovery process have been identified as the key causes behind frozen shoulders. However, Parkinson's disease is also considered a cause of frozen shoulders. People having diabetes and hyperthyroidism are more chances to be affected by frozen shoulders. In this regard, Arthroscopic capsular release (ACR), Manipulation under anesthesia (MUA) and intra-articular steroid injection (ISI) has been considered the key approaches regarding the treatment of frozen shoulders. However, due to the presence of inflammatory properties that help in reducing inflammation within the should joint as well as reducing the pain, corticosteroid injection has been considered as the effective approach to reducing the pain of the patient having frozen shoulders.
Chen, R., Jiang, C., & Huang, G. (2019). Comparison of intra-articular and subacromial corticosteroid injection in frozen shoulder: A meta-analysis of randomized controlled trials. International Journal of Surgery, 68, 92-103. https://doi.org/10.1016/j.ijsu.2019.06.008
Cho, C. H., Min, B. W., Bae, K. C., Lee, K. J., & Kim, D. H. (2021). A prospective double-blind randomized trial on ultrasound-guided versus blind intra-articular corticosteroid injections for primary frozen shoulder. The Bone & Joint Journal, 103(2), 353-359. https://doi.org/10.1302/0301-620X.103B2.BJJ-2020-0755.R1
Dai, Z., Liu, Q., Liu, B., Long, K., Liao, Y., Wu, B., ... & Liu, C. (2022). Combined arthroscopic release with corticosteroid hydrodilatation versus corticosteroid hydrodilatation only in treating freezing-phase primary frozen shoulder: a randomized clinical trial. BMC Musculoskeletal Disorders, 23(1), 1-7. https://doi.org/10.1186/s12891-022-06065-3
Date, A., & Rahman, L. (2020). Frozen shoulder: overview of clinical presentation and review of the current evidence base for management strategies. Future Science OA, 6(10), FSO647. https://doi.org/10.2144/fsoa-2020-0145
Karbowiak, M., Holme, T., Mirza, M., & Siddiqui, N. (2022). Frozen shoulder. bmj, 377. https://doi.org/10.1136/bmj-2021-068547
Lee, C. W., Kim, I. S., Kim, J. G., Hwang, H., Jung, I. Y., Lee, S. U., & Seo, K. S. (2022). Effects of Hydrodilatation With Corticosteroid Injection and Biomechanical Properties in Patients With Adhesive Capsulitis After Breast Cancer Surgery. Annals of Rehabilitation Medicine, 46(4), 192-201. https://doi.org/10.5535/arm.22059
Millar, N. L., Meakins, A., Struyf, F., Willmore, E., Campbell, A. L., Kirwan, P. D., ... & Rodeo, S. A. (2022). Frozen shoulder. Nature Reviews Disease Primers, 8(1), 1-16. https://doi.org/10.1038/s41572-022-00386-2
Papalia, R., Torre, G., Papalia, G., Baums, M. H., Narbona, P., Di Lazzaro, V., & Denaro, V. (2019). Frozen shoulder or shoulder stiffness from Parkinson disease?. Musculoskeletal surgery, 103(2), 115-119. https://doi.org/10.1007/s12306-018-0567-3
Rae, G. C., Clark, J., Wright, M., & Chesterton, P. (2020). The effectiveness of hydrodistension and physiotherapy following previously failed conservative management of frozen shoulder in a UK primary care centre. Musculoskeletal Care, 18(1), 37-45. https://doi.org/10.1002/msc.1438
Rangan, A., Brealey, S. D., Keding, A., Corbacho, B., Northgraves, M., Kottam, L., ... & Venateswaran, B. (2020). Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial. The Lancet, 396(10256), 977-989. https://doi.org/10.1016/S0140-6736(20)31965-6
Razmjou, H. (2022). Frozen Shoulder. In Clinical and Radiological Examination of the Shoulder Joint (pp. 75-88). Springer, Cham. https://doi.org/10.1007/978-3-031-10470-1_6
Silvestri, E., Orlandi, D., Muda, A., & Martino, F. (2022). Frozen Shoulder. In Musculoskeletal Ultrasound in Orthopedic and Rheumatic disease in Adults (pp. 137-142). Springer, Cham. https://doi.org/10.1007/978-3-030-91202-4_16
Song, C., Song, C., & Li, C. (2021). Outcome of manipulation under anesthesia with or without intra-articular steroid injection for treating frozen shoulder: A retrospective cohort study. Medicine, 100(13). https://doi.org/10.1097%2FMD.0000000000023893
Sundararajan, S. R., Dsouza, T., Rajagopalakrishnan, R., Bt, P., Arumugam, P., & Rajasekaran, S. (2022). Arthroscopic capsular release versus manipulation under anaesthesia for treating frozen shoulder—a prospective randomised study. International Orthopaedics, 46(11), 2593-2601. https://doi.org/10.1007/s00264-022-05558-z
Zhang, J., Zhong, S., Tan, T., Li, J., Liu, S., Cheng, R., ... & Ye, X. (2021). Comparative efficacy and patient-specific moderating factors of nonsurgical treatment strategies for frozen shoulder: an updated systematic review and network meta-analysis. The American Journal of Sports Medicine, 49(6), 1669-1679. https://doi.org/10.1177/0363546520956293.
