Does Chondrolysis Occur after Corticosteroid-analgesic Injections? An Analysis of Patients Treated for Adhesive Capsulitis of the Shoulder

OBJECTIVES: There has been growing concern about the deleterious effects of local anaesthetics on articular cartilage. Clinical studies using continuous infusions of local anaesthetics and basic science studies that model both continuous and single injection of local anaesthetics have demonstrated chondrotoxicity. However, clinical studies do not exist that assess for the risk of chondrolysis on non-arthritic joints exposed to single or intermittent corticosteroid/analgesic injections. METHODS: A retrospective review of patient treated for adhesive capsulitis of the shoulder with at least one intra-articular injection of corticosteroid and local anaesthetic was performed. Inclusion criteria were a diagnosis of primary or intrinsic and systemic secondary adhesive capsulitis and a minimum two year follow-up period. Exclusion criteria were patients with extrinsic secondary adhesive capsulitis. Prospective follow-up was performed to obtain patient-determined outcome scores, range of motion, and radiographs to determine the presence of chondrolysis. RESULTS: Fifty-six patients with a mean age of 52.5+7.23 years were enrolled in this study at a mean follow-up of 54 months. The mean number of injections performed was 1.45+0.69 (range 1-4). The mean amount of methylprednisolone acetate used per patient was 111 mg (range 80-320 mg). A mean of 3 ml 0.25% bupivicaine (range 0-12 ml), 2.94 ml of 0.5% bupivicaine (range 0-8.5 ml), and 5.46 ml 1% lidocaine (range 0-16.5 ml) was used per patient. At final follow-up, the mean WOOS was 91.4+14.2%, DASH was 6.66+9.60, SPADI was 7.41+11.4, and SANE was 92.7+10.1%. The Shoulder Activity Score was 8.25+4.71. Initial mean active forward elevation was 110+24º and external rotation was 13+19º. At final follow-up, mean forward elevation (155+11º) and external rotation (65+14º) were improved (P<0.0001). Passive and active forward elevation, external rotation, internal rotation, and cross-body adduction demonstrated no significant differences with the unaffected contralateral shoulder. There was no radiographic evidence of chondrolysis in any patient. Twelve patients (21.4%) did not respond to the nonoperative treatment and required arthroscopic capsular release. CONCLUSION: This study did not demonstrate chondrolysis in patients treated with intraarticular corticosteroid and local anaesthetic for adhesive capsulitis. At final follow-up, this cohort had normalized patient-derived outcome scores and symmetric range of motion with the contralateral shoulder. The findings of this study do not support the cessation of using intraarticular analgesic/corticosteroid injections for the treatment of adhesive capsulitis. However, the authors do recommend caution and surveillance with continued intra-articular use of corticosteroid/anaesthetic combinations.