Ann Rehabil Med.  2013 Apr;37(2):208-214. 10.5535/arm.2013.37.2.208.

A Comparison of the Short-Term Effects of a Botulinum Toxin Type A and Triamcinolone Acetate Injection on Adhesive Capsulitis of the Shoulder

• Joo YJ
• Yoon SJ
• Kim CW
• Lee JH
• Kim YJ
• Koo JH
• Song SH

• KMID: 2165772
• DOI: http://doi.org/10.5535/arm.2013.37.2.208

Abstract

OBJECTIVE
To evaluate the short-term clinical effects of the intra-articular injection of botulinum toxin type A (BoNT-A) for the treatment of adhesive capsulitis.
METHODS
A prospective, controlled trial compared the effects of intra-articular BoNT-A (Dysport; 200 IU, n=15) with the steroid triamcinolone acetate (TA; 20 mg, n=13) in patients suffering from adhesive capsulitis of the shoulder. All patients were evaluated using a Numeric Rating Scale (NRS) of the pain intensity and a measurement of the range of motion (ROM) at baseline (before treatment) and at 2, 4, and 8 weeks post-treatment.
RESULTS
The NRS at 2 weeks (BoNT-A vs. TA; 5.0 vs. 5.2), 4 weeks (4.1 vs. 4.9) and 8 weeks (3.8 vs. 4.6) of both treatment groups were significantly lower than that measured at baseline (7.4 vs. 7.6). The ROM of patients' shoulders increased significantly from baseline in both treatment groups. There was no significant difference in the NRS of pain intensity or the ROM between the two groups. Reduction in the pain intensity score was maintained for 8 weeks post-injection in both groups. There were no significant adverse events in either treatment group.
CONCLUSION
The results suggest that there are no significant short-term differences between the intra-articular injections of BoNT-A and TA. Although BoNT-A has a high cost, it may be used as a safe alternative of TA to avoid the steroid-induced side effects or as a second-line agent, for patients who have failed to respond to the current treatments.

Keyword

Adhesive capsulitis; Botulinum toxin type A; Intra-articular injections

MeSH Terms

Adhesives
Botulinum Toxins
Botulinum Toxins, Type A
Bursitis
Humans
Injections, Intra-Articular
Prospective Studies
Range of Motion, Articular
Shoulder
Stress, Psychological
Triamcinolone
Adhesives
Botulinum Toxins
Botulinum Toxins, Type A
Triamcinolone

Figure

• 

  Fig. 1 Mean numeric rating scale (NRS) scores for the intra-articular TA and BoNT-A treatment groups. Both treatment groups showed a significant decrease in the NRS scores compared to baseline at week 8. BoNT-A, botulinum toxin type A (Dysport); TA, triamcinolone acetate. †Significant difference (p<0.05) compared to the baseline value.

• 

  Fig. 2 Mean range of motion (ROM) assessments between the intra-articular TA group and the BoNT-A group. Both treatment groups produced significant improvements in the active shoulder abduction (A), flexion (B), the passive shoulder abduction (C), and external rotation (D) compared to baseline at week 8 (†p<0.05). Improvements in the range of the passive and active abduction (A, C) were significantly greater in the BoNT-A group than in the TA group. BoNT-A, botulinum toxin type A (Dysport); TA, triamcinolone acetate. †Significant difference (p<0.05) compared to the baseline value. *Significant difference (p<0.05) compared to the BoNT-A group.

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