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Flare Reaction Following Intra-articular Steroid Injection in Frozen Shoulder. A Retrospective Study
Ankur Khandelwal1, Sanghamitra Sarma2, Anirban Bhattacharjee1
1Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, Guwahati, Assam, India.
Journal of Research in Pharmacy Practice
|August 5, 2026
Summary
Flare reactions after ultrasound-guided steroid injections for frozen shoulder occur in 22.6% of patients. Most are mild, but severe cases can be effectively managed with buprenorphine or diclofenac.
Area of Science:
- Orthopedics
- Pain Management
- Radiology
Background:
- Frozen shoulder (adhesive capsulitis) is a debilitating condition.
- Ultrasound-guided intra-articular steroid injection (US-guided IASI) is a common treatment.
- Post-injection flare reactions can cause significant pain and anxiety.
Purpose of the Study:
- To determine the incidence, severity, temporal profile, and management outcomes of flare reactions after US-guided IASI for frozen shoulder.
Main Methods:
- Retrospective study of adult patients undergoing US-guided glenohumeral joint IASI.
- Flare reactions assessed using Numeric Rating Scale at 1, 4, and 24 hours post-injection.
- Analgesic strategies evaluated based on pain severity.
Main Results:
- Flare reaction occurred in 19 (22.6%) of 84 patients.
- Most reactions were mild (63.2%) and self-limiting.
- Moderate-to-severe reactions (36.8%) required pharmacological treatment, with sublingual buprenorphine effective for early-onset severe pain and oral diclofenac for late-onset moderate pain, all without adverse effects.
Conclusions:
- Flare reactions after US-guided IASI for frozen shoulder are common but manageable.
- Appropriate analgesic strategies, including sublingual buprenorphine and oral diclofenac, ensure effective symptom control.
- US-guided IASI remains a safe and effective treatment option for frozen shoulder.
