유착성 견관절염 환자에서 하이알루론산과 스테로이드 병용요법의 효과
Treatment of Adhesive Capsulitis with Steroid Injection Followed by Hyaluronic Acid Injection
1
조회
0
다운로드
5
인용
0
참고문헌
키워드
초록
Objective: To investigate the effects of sono-guided intraarticular steroid injection followed by sodium hyaluronate injection weekly for 2 weeks on adhesive capsulitis of the shoulder Method: In this prospective randomized controlled trial, 16 patients (group A) were treated with intraarticular injection with a mixture of 0.5% lidocaine 9 ml and triamcinolone 40 mg once a week for 3 weeks, and 13 patients (group B) were treated with intraarticular injection with a mixture of 0.5% lidocaine 9 ml and triamcinolone 40 mg for the first week, and subsequently a mixture of 0.5% lidocaine 8 ml and sodium hyaluronate 2 ml once a week for the next 3 weeks. A self exercise program was instructed for all subjects. The effects were assessed using visual numeric scale (VNS), shoulder pain and disability index (SPADI), and range of shoulder motion (flexion, abduction, internal rotation. external rotation, and extension) at study entry, every week until 2 weeks have passed after the last injection. Results: The VNS, SPADI, and range of shoulder motion improved 1 week after 1st injection and continued to improve until 2 weeks after last injection in both two groups. There were no difference in changes of VNS and SPADI between these two groups, but range of shoulder motion especially in passive and active internal rotation of patients in group A improved more than those in group B. Conclusion: Steroid injection combined with hyaluronic acid injection has comparable effects with triamcinolone for treatment of adhesive capsulitis of the shoulder. Sono-guided intraarticular injection of steroid combined with hyaluronic acid can substitute for intraarticular injection of triamcinolone and be useful especially for patients susceptible to adverse effects of steroid injection. (J Korean Acad Rehab Med 2010; 34: 310-315)
Abstract
Objective: To investigate the effects of sono-guided intraarticular steroid injection followed by sodium hyaluronate injection weekly for 2 weeks on adhesive capsulitis of the shoulder Method: In this prospective randomized controlled trial, 16 patients (group A) were treated with intraarticular injection with a mixture of 0.5% lidocaine 9 ml and triamcinolone 40 mg once a week for 3 weeks, and 13 patients (group B) were treated with intraarticular injection with a mixture of 0.5% lidocaine 9 ml and triamcinolone 40 mg for the first week, and subsequently a mixture of 0.5% lidocaine 8 ml and sodium hyaluronate 2 ml once a week for the next 3 weeks. A self exercise program was instructed for all subjects. The effects were assessed using visual numeric scale (VNS), shoulder pain and disability index (SPADI), and range of shoulder motion (flexion, abduction, internal rotation. external rotation, and extension) at study entry, every week until 2 weeks have passed after the last injection. Results: The VNS, SPADI, and range of shoulder motion improved 1 week after 1st injection and continued to improve until 2 weeks after last injection in both two groups. There were no difference in changes of VNS and SPADI between these two groups, but range of shoulder motion especially in passive and active internal rotation of patients in group A improved more than those in group B. Conclusion: Steroid injection combined with hyaluronic acid injection has comparable effects with triamcinolone for treatment of adhesive capsulitis of the shoulder. Sono-guided intraarticular injection of steroid combined with hyaluronic acid can substitute for intraarticular injection of triamcinolone and be useful especially for patients susceptible to adverse effects of steroid injection. (J Korean Acad Rehab Med 2010; 34: 310-315)
참고문헌 (34)
- Wadsworth CT, "Frozen shoulder", Phy Ther, 66, pp.1878~1883 (1986)
- Neviaser JS, "Adhesive capsulitis of the shoulder: a study ofthe pathologic findings in peria rthritis of the shoulder", J Bone Joint Surg Am, 27, pp.211~222 (1945)
- Neviaser RJ, "The frozen shoulder. Diagnosis and management", Clin orthop Relat Res, 223, pp.59~64 (1987)
- Gam AN, "Treatment of frozen shoulder with distension and glucocorticoid compared with glucocorticoid alone", Scand J Rheumatol, 27, pp.425~430 (1998)
- Dias R, "Frozen shoulder", BMJ, 331, pp.1453~1456 (2005)
- Siegel LB, "Adhesive capsulitis: a sticky issue", Am Fam Physician, 59, pp.1843~1852 (1999)
- Noel E, "Frozen shoulder", Joint Bone Spine, 67, pp.393~400 (2000)
- Iwata H, "Pharmacologic and clinic aspects of intraarticular injection of hyaluronate", Clin Orthop Relat, 289, pp.285~291 (1993)
- Itokazu M, "Clinical evaluation of high molecular-weight sodium hyaluronate for the treatment of patients with periarthritis of the shoulder", Clin Ther, 17, pp.946~955 (1995)
- Leardini G, "Intra- articular injections of hyaluronic acid in the treatment of painful shoulder", Clin Ther, 10, pp.521~526 (1988)
- Rovetta G, "Intraarticular injection of sodium hyaluronate plus steroid versus steroid in adhesivecapsulitis of the shoulder", Int J Tissue React, 20, pp.125~130 (1998)
- Kim C, "The effect of sono-guided intraarticular injection of hyaluronate in shoulder adhesive capsulitis", J Korean Assoc Pain Med, 6, pp.82~88 (2007)
- Roach KE, "Development of a shoulder pain and disability index", Arthritis Care Res, 4, pp.143~149 (1991)
- Mclaughlin HL, "On the frozen shoulder", Bull Hosp Joint Dis, 12, pp.383~393 (1951)
- Rodeo SA, "Immunolocalization of cytokines and their receptors in adhesive capsulitis of the shoulder", J Orthop Res, 15, pp.427~436 (1997)
- Rizk TE, "Frozen shoulder", Semin Arthritis Rheum, 11, pp.440~452 (1982)
- Steinbrocker O, "Frozen shoulder: treatment by local injection of depot corticost eroid", Arch Phys Med Rehabil, 55, pp.209~213 (1974)
- Roy S, "Management of painful shoulder", Lancet, 1, pp.1322~1324 (1976)
- Buchbinder R, "Corticosteroid injections for shoulder pain", Cochrane Database Syst Rev, 1 (2003)
- Bulgen DY, "Frozen shoulder: prospective clinical study with an evaluation of three treatment regimens", Ann Rheum Dis, 43, pp.353~360 (1984)
- Dacre JE, "Injection and physiotherapy for the painful stiff shoulder", Ann Rheum Dis, 48, pp.322~325 (1989)
- Miller MD, "Thawing the frozen shoulder: the ‘patient’ patient", Orthopaedics, 19, pp.849~853 (1996)
- Speed C, "Shoulder pain", Clin Evid, 9, pp.1372~1387 (2003)
- Arroll B, "Corticosteroids for painful shoulder: a metaanalysis", Br J Gen Pract, 55, pp.224~228 (2005)
- 조강희, "유착성 견관절낭염 환자에서 견봉하 활액낭 내 하이알루론산 주사의 효과-다기관, 전향적 연구-", Annals of Rehabilitation Medicine, 26(1), pp.13~80 (2002), 대한재활의학회
- Kennedy JC, "The effect of local steroid injections on tendons: a biomechanical and microscopic correlative study", Am J Sports Med, 4, pp.11~21 (1976)
- Sweetnam R, "Corticosteroid arthropathy and tendon rupture", J Bone Joint Surg Br, 51, pp.397~398 (1969)
- Paavola M, "Treatment of tendon disorders. Is there a role for corticosteroid injection?", Foot Ankle Clin, 7, pp.501~513 (2002)
- Shrier I, "Achilles tendonitis: are corticosteroid injections useful or harmful?", Clin J Sport Med, 6, pp.245~250 (1996)
- Yoshimi T, "Effects of high-molecular weight sodium hyaluronate on experimental osteoarthrosis induced by the resection of rabbit anterior cruciate ligament", Clin Orthop Relat Res, 298, pp.296~304 (1994)
- Sakurai K, "Anti-inflammatory activity of super oxide dismutase conjugated with sodium hyaluronate", Glycoconj J, 14, pp.723~728 (1997)
- Yamakado K, "The targeting accuracy of subacromial injection to the shoulder: an arthrographic evaluation", Arthroscopy, 18, pp.887~891 (2002)
- Partington PF, "Diagnostic injection around the shoulder: hit and miss? a cadaveric study of injection accuracy", J Shoulder Elbow Surg, 7, pp.147~150 (1998)
- Kim HY, "The effect of intraarticular injection of hyaluronic acid and steroid in adhesive capsulitis of shoulder", J Korean Acad Rehabil Med, 23, pp.117~123 (1999)