Corticosteroids

Corticosteroids can be administered by injection to dampen the inflammatory

response in patients with FS. Significant evidence demonstrates that intra-
articular corticosteroid injections provide significant improvements of symptomps
in the first 4 to 6 weeks of the intervention. 24, 30, 35, 36, 43 Although no long term
differences can be attributed to corticosteroids, the belief is that the patient can
be made more comfortable at rest and with functional movement and the
synovitis stage possibly shortened, thereby hastening the time needed to
achieve end-range stretching of fibrotic tissue.

Proposed Intervention Algorithm

An algorithmic approach offering conservative and surgical interventions can
effectively address the FS continuum (Fig. 90-2). The patient is seen by the
shoulder service surgeon, physician, or therapist and diagnosed with FS. The
patient is given one of four treatment options based on the known pathology,
and evidence based literature. The patient is given the option to receive an intra-
articular corticosteroid injection. Whether he or she receives the injection or not,
the patient is referred to physical therapy for either a home exercise program
(HEP) or supervised therapy (ST). There is not clear evidence to determine which
patients may need formal ST rather than simply a HEP. Therefore the decision is
made based on the physicians and patients preference with input from the
therapist after initial evaluation. Factors that may favor use