Fysioterapeuten 1-2022

VITENSKAPELIG ARTIKKEL 40 FYSIOTERAPEUTEN 1/22 Management of Frozen Shoulder Using Corti - costeroid Injection Therapy: An Evaluation of Current Practice among Physical Therapists Providing Injection Therapy in Norway Abstract Introduction : Although several interventions have been proposed for frozen shoulder, there is a lack of evidence regarding the best care for the condition, especially concerning corticosteroid treatment and the number of injections used. The treatment strategies and clinical reasoning behind the management among physical thera- pists providing injection therapy have not previously been evaluated. Methods : A cross-sectional online survey was distribu- ted among 138 Norwegian physical therapists providing injection therapy to evaluate current practice regarding their management of frozen shoulder with corticosteroid injections. Descriptive statistics were used to identify trends in current practice, which were further evaluated in relation to the available literature. Results : The majority of the 32 respondents used multiple ultrasound-guided intra-articular corticosteroid injections for frozen shoulder. None reported to usually achieve satisfactory results following only a single injec- tion, while 87.1 % reported this following 2-3 injections. The use of functional outcome measures as part of the evaluation and decision-making is generally limited among the respondents. Conclusion : Multiple intra-articular corticosteroid injec- tions are currently used in practice in Norway, with the respondents reporting beneficial outcomes following 2-3 injections. However, their efficacy compared to a single injection needs further investigation. Keywords : Physical Therapy Modalities, Surveys and Questionnaires, Shoulder Injection. Joakim Moestue Halvorsen , Forsterket rehabilitering Aker, Helseetaten, Oslo kommune, Oslo, Norway.  joakim.halvorsen@outlook.com. Nick Worth , University of Salford, Salford, GB and Queen Margaret University, Edinburgh, GB. Cathy Bulley , Queen Margaret University, Edinburgh, GB. This scientific article has been peer-reviewed according to Fysioterapeuten’s guidelines, and was accepted on November 2nd, 2021. Ethical approval was granted by the Queen Margaret University (QMU) Divisional Research Ethics Committee. No conflicts of interest stated. Note: Moestue Halvorsen is associated with Fysioterapeuten in connection with the podcast «Lateralt og medialt – en podcast om fysioterapi». This paper was first published at www.fysioterapeuten.no. Introduction Frozen shoulder is a debilitating condition identified by severe pain and stiffness of the shoulder and has been as- sociated with reduced quality of life among individuals living with the condition (1). Although it can be secon- dary to trauma or prolonged immobilization, primary frozen shoulder is seen as an idiopathic process marked by initial inflammation and subsequent fibrosis, capsular contracture, and reduced joint volume (2, 3). Since the se- minal paper by Reeves (4) in 1975 on the natural history of frozen shoulder, the condition has been thought of as self- limiting, leading to full resolution without treatment after one to three years. However, a recent systematic review by Wong et al. (5) found that the condition could still cause symptoms and disability several years after onset. Frozen shoulder has traditionally been reported to oc- cur in 2-5 % of the general population, although there are uncertainties regarding the actual life-time prevalence of