Efficacy of Combined Intra-articular Steroids and Calcitonin Nasal Spray versus Intra-articular Steroids Alone in the Management of Early Frozen Shoulder: A Prospective Study.

Abstract

Introduction: Frozen shoulder is one of the commonest debilitating conditions with characteristic features of by pain and globally restricted range of motion of the shoulder. This study compares the efficacy of intra-articular steroids alone in comparison to the combined intra-articular steroids and calcitonin nasal spray in the management of early-stage frozen shoulder. We hypothesized that the combination therapy of intra-articular steroids and calcitonin nasal spray results in a better increase in shoulder function and superior pain relief. Along with decrease in disability in comparison to treatment with corticosteroids alone.

Materials and methods: Less than 3 months was chosen as a critical period for defining early frozen shoulder. A prospective study was conducted on 434 patients diagnosed with early-stage frozen shoulder. Randomization of the patients was done in two treatment groups according to computer-generated tables after applying appropriate inclusion and exclusion criteria and taking written consent. Patients were randomly assigned to two groups: Group A received intra-articular corticosteroid injections alone, and Group B received a combination of intra-articular corticosteroid injections and calcitonin nasal spray. Post-intervention physiotherapy protocol was the same for both the groups. Paracetamol @ 15 mg/kg was used for pain management as and when required. To measure the outcomes, the Oxford Shoulder Score (OSS) was used at 12 weeks post-intervention.

Results: There was improvement in OSS scores compared to baseline, which was found to be both clinically and statistically significant (P < 0.05). Patients who received combination therapy, i.e., Group B, exhibited superior clinical outcomes compared to patients who received intra-articular injections alone, i.e., Group A, at 12 weeks post-treatment. Group B demonstrated greater improvement in OSS scores (P < 0.001) as compared to Group A. Twenty-eight patients were lost to follow-up and 15 patients required analgesia like non-steroidal anti-inflammatory drugs other than paracetamol and hence excluded from the study.

Conclusion: The combination therapy of intra-articular corticosteroids and calcitonin nasal spray was found to be more efficacious as compared to intra-articular corticosteroids alone in the treatment of early-stage frozen shoulder. This combination therapy of intra-articular steroids and calcitonin provides better pain relief and shoulder function. This decrease in disability suggests its potential as a promising treatment option in the management of patients with early frozen shoulder.