Flare Reaction Following Intra-articular Steroid Injection in Frozen Shoulder. A Retrospective Study.

OBJECTIVES

The objectives of this study were to determine the incidence, severity, temporal profile, and management outcomes of flare reactions following ultrasound (US)-guided intra-articular steroid injection (IASI) for frozen shoulder.

METHODS

This retrospective study included adult patients undergoing US-guided glenohumeral joint IASI for frozen shoulder over 1 year. Flare reactions were assessed using the Numeric Rating Scale at 1-, 4-, and 24-h postinjection. Analgesic strategies were evaluated based on pain severity.

FINDINGS: Among 84 patients, flare reaction occurred in 19 (22.6%). Most reactions were mild (63.2%) and self-limiting. Moderate-to-severe reactions (36.8%) required pharmacological treatment. Early-onset severe pain responded rapidly to low-dose sublingual buprenorphine, with complete relief in most patients within 4 h, while late-onset moderate pain was effectively managed with oral diclofenac. No adverse effects were observed.

CONCLUSION

Flare reaction after IASI for frozen shoulder is not uncommon and, in most cases, can be effectively managed with appropriate analgesic strategies. Sublingual buprenorphine for moderate-severe early-onset pain ensures effective symptom control without major side effects.