Systematic reviewThe effectiveness of corticosteroid injections compared with physiotherapeutic interventions for adhesive capsulitis: A systematic review
Section snippets
Background
Adhesive capsulitis, also termed ‘frozen shoulder’, is a common cause of shoulder pain which is estimated to affect between 2% and 5% of the population [1]. It is characterised by a spontaneous onset of pain with progressive, global stiffness of the glenohumeral joint which can lead to a gross loss of function.
The term ‘frozen shoulder’ was first described by Codman in 1934 [2] because of the painful restriction of movement associated with the disease. The term ‘adhesive capsulitis’, which
Objective of the review
The primary objective of this systematic review was to present the best-available evidence comparing the effectiveness of corticosteroid injections with physiotherapeutic interventions for the management of adhesive capsulitis/frozen shoulder.
Search strategy
The following electronic databases were searched via the EBSCOhost searching interface: MEDLINE (1966 to Week 23 2009), CINAHL (1982 to Week 23 2009) and AMED (1985 to Week 23 2009). EMBASE (1980 to Week 23 2009) was searched via the OVID searching interface. Truncation symbols were included within the headings and keywords. An example of the EMBASE search is outlined in Box 1. The Cochrane Central Register of Controlled Clinical Trials was searched using combinations of the search terms:
Results
Ten potential studies were identified from the search strategy [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], six of which met the criteria for inclusion in the review [31], [32], [33], [34], [35], [36]. An attempt was made to retrieve all 10 articles for further review. One of these trials [27] (identified via NRR) had not yet been published. The author was contacted directly but due to problems with recruitment, the study had been withdrawn and no data were available. Data from
Discussion
The findings of this review indicate that the treatment of adhesive capsulitis with corticosteroid injections is more effective than physiotherapeutic interventions in the short term, and to a lesser extent in the longer term. Despite these findings, the results must be interpreted with caution as marked heterogeneity was apparent for one of the outcomes. Ryans et al.[31] found physiotherapeutic interventions to be more favourable than corticosteroid injections in reducing pain at both 6 and 16
Conclusion
The findings of this review suggest that corticosteroid injections are more beneficial than physiotherapeutic interventions in the treatment of adhesive capsulitis in the short term, and to a lesser extent in the longer term, in terms of improving shoulder disability, pain and range of movement. Injection therapy appears to have the most significant effect after around 6 to 7 weeks, with the greatest effect being seen on functional outcome. This study allows more definitive conclusions to be
References (44)
- et al.
The PEDro scale provides a more comprehensive measure of methodological quality than the Jadad scale in stroke rehabilitation literature
J Clin Epidemiol
(2005) - et al.
Balneotherapy and quality assessment: interobserver reliability of the Maastricht criteria list for blinded quality assessment
J Clin Epidemiol
(1998) - et al.
Distension arthrography in the treatment of adhesive capsulitis of the shoulder
J Vasc Interv Radiol
(1994) - et al.
Physical therapy for adhesive capsulitis: systematic review
Physiotherapy
(2002) The shoulder
(1934)Adhesive capsulitis of the shoulder: a study of the pathological findings in periarthritis of the shoulder
J Bone Joint Surg
(1945)- et al.
The pathology of frozen shoulder. A Dupuytren-like disease
J Bone Joint Surg
(1995) - et al.
Immunolocalization of cytokines and their receptors in adhesive capsulitis of the shoulder
J Orthopaed Res
(1997) - et al.
Adhesive capsulitis: a treatment approach
Clin Orthop Relat Res
(2000) - et al.
End-range mobilisation techniques in adhesive capsulitis of the shoulder joint: a multiple-subject case report
Phys There
(2000)