Analgesia for adhesive capsulitis
In all phases of adhesive capsulitis, but particularly the initial painful phase, adequate analgesia is important. Analgesic options includeYip, 2018:
- oral paracetamol
- topical and oral nonsteroidal anti-inflammatory drugs (NSAIDs)
- local intra-articular corticosteroid injection to the glenohumeral joint
- local anaesthetic suprascapular nerve blockChang, 2016.
In the initial painful phase, intra-articular corticosteroid injection to the glenohumeral joint has been shown to be useful for rapid pain relief but has a short duration of effect. Glenohumeral joint injections should be performed with radiological guidance1. Intra-articular corticosteroid injections improve functional performance and range of shoulder motion, these effects being significant at 4 to 6 weeksKitridis, 2019Sun, 2017. Local corticosteroid injection may cause a transient increase in blood glucose concentration, but usually no adjustment to diabetes treatment is necessary. For principles of use and example doses of local corticosteroid injections, see Principles of using local corticosteroid injections for musculoskeletal pain.
There is some low-level evidence for the use of oral corticosteroids in the initial painful phase of adhesive capsulitis. Oral corticosteroids may provide rapid pain relief and improve function and range of shoulder motion, but the effect may not last beyond 6 weeksBuchbinder, 2006Kitridis, 2019Yip, 2018.
A local anaesthetic suprascapular nerve block is sometimes used for short-term analgesia in adhesive capsulitis. This procedure should be performed with ultrasound guidanceChang, 2016.
Opioids should not routinely be used in the management of adhesive capsulitis because of a lack of evidence for efficacy and a significant risk of harms.