凍結肩 (Frozen shoulder) に対するステロイド内服療法の効果（第2報)

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Since frozen shoulder (adhesive capsulitis) is characterized by spontaneous recovery, no precise treatment strategy exists. Conservative therapy is available in the form of physical therapy, and injection therapy, and joint manipulation, release of the ligaments, and arthroscopic surgery are available as surgical therapies, but the time required for recovery varies considerably. Nevertheless, there have been very few reports on medication therapy. In this study we found that it was possible to obtain early symptom relief with oral steroid therapy. The criteria for inclusion in this study were absence of osteoarthritic changes or calcification on plain radiographs, absence of rotator cuff injury, including an incomplete rupture, on MR images, and a negative supraspinatus muscle (empty-can) test. There were 53 patients (30 males, 23 females), and their ages at the time of treatment ranged from 33 to 67 years old (mean: 55.6 years old). Complications consisted of diabetes mellitus in 2 patients, and hypertension in 7 patients. A single course of steroid therapy consisted of a total dose of 105 mg of prednisolone over approximately a 3-week period by the dose-tapering method. The number of courses varied with the degree of symptom relief, but the rest period between courses was always approximately 4 weeks. The results of treatment were assessed on the basis of the JOA score, but the principal items assessed were pain and range of motion. The evidence of inflammation of the shoulder joint before treatment was evaluated by gallium scintigraphy, was noted in 14 of the 17 patients. The ranges of motion before treatment were 102.8° of anterior elevation and 11.3° of external rotation, and internal rotation was at the buttocks in almost every case. However, after 1 course of treatment, anterior elevation was 136°, external rotation was 33.7°, and internal rotation was limited to the buttocks in only 6 cases. The results of oral steroid therapy for frozen shoulder (adhesive capsulitis) were highly satisfactory. However, sufficient care was required in explaining the method of administration in case side effects exist, such as the development of femoral head necrosis.
日本肩関節学会の論文

凍結肩 (Frozen shoulder) に対するステロイド内服療法の効果（第2報)

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