What is the role of oral corticoids in the treatment of frozen shoulder syndrome (FSS) (adhesive capsulitis)?

Updated: Nov 12, 2020
  • Author: Jefferson R Roberts, MD; Chief Editor: S Ashfaq Hasan, MD  more...
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Answer

Oral corticosteroids can be prescribed in lieu of NSAIDs, as they provide a stronger anti-inflammatory effect, however they should not be given routinely due to their potential adverse effects. The use of low-dose oral corticosteroids is recommended only in cases of severe refractory frozen shoulder that has either been present for an extended period (ie, longer than 2 months) or is causing significant pain. [13, 53, 54] Although oral corticosteroids provide significant short-term benefits, the effect may not be maintained beyond 6 weeks. [55]

Due to the potential adverse effects of corticosteroids, the patient should be thoroughly questioned regarding past medical history, including diabetes mellitus. Diabetes mellitus is not an absolute contraindication to the use of oral corticosteroids, but given the potential hyperglycemic effects of corticosteroids, these agents should be used judiciously and the patient's blood glucose should be closely monitored.  

Oral steroids are typically given in a 3-week tapered course of prednisone, although treatment may range from 2-6 weeks. [55] See Table 3, below.

Table 3. Prednisone Dosing in Patients With Refractory Frozen Shoulder Syndrome (Open Table in a new window)

Week

Dose

1 (Days 1-7)

40 mg/d

2 (Days 8-14)

30 mg/d

3 (Days 15-18)

20 mg/d

4 (Days 19-21)

10 mg/d

5 (Days 22)

Discontinue

Note: Before oral corticosteroid medication is prescribed, the patient should be extensively questioned about pertinent medical problems that may be contraindications to taking the medicine.


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