Elsevier

Physiotherapy

Volume 96, Issue 2, June 2010, Pages 95-107
Physiotherapy

Systematic review
The effectiveness of corticosteroid injections compared with physiotherapeutic interventions for adhesive capsulitis: A systematic review

https://doi.org/10.1016/j.physio.2009.09.003Get rights and content

Abstract

Objectives

To determine the effectiveness of corticosteroid injections compared with physiotherapeutic interventions for the treatment of adhesive capsulitis/frozen shoulder.

Data sources

The electronic databases MEDLINE, EMBASE, CINAHL and AMED were searched up to Week 23 2009. Additional database searching included the Cochrane Central Register of Controlled Clinical Trials, the Physiotherapy Evidence Database (PEDro), the National Research Register and the National Recognition Information Centre, also up to Week 23 2009.

Review methods

All English-language studies were eligible for inclusion if they showed evidence of random allocation of subjects to either a corticosteroid injection group or a physiotherapeutic intervention group. Studies were considered for inclusion if participants had a stated diagnosis of adhesive capsulitis/frozen shoulder or restriction of passive or active movement in two or more planes. The primary outcomes of interest were pain, external rotation and shoulder disability/function. Quality assessment was assessed using the PEDro scale. Standardised mean differences and effect estimates were calculated for the outcomes of pain, external rotation and shoulder disability at various follow-up periods.

Results

Six studies were deemed eligible for inclusion in the final review. All had evidence of random allocation to either an injection group or a physiotherapeutic intervention group. There were some differences between the studies with regard to both the corticosteroid injections and physiotherapeutic interventions. Standardised mean differences and effect estimates were calculated for three of the included studies at various follow-up periods. There was a medium effect for corticosteroid injections compared with physiotherapeutic interventions for the outcomes of pain, passive external rotation and shoulder disability at 6 weeks. There was only a small effect in favour of corticosteroid injections for pain, passive external rotation and shoulder disability at 12 to 16 weeks and 26 weeks, and pain and shoulder disability at 52 weeks.

Conclusion

The results of this review suggest that corticosteroid injections have greater effect in the short term compared with physiotherapeutic interventions. This decreased over time, with only a small effect in favour of injections in the longer term. The results of this review must be interpreted with some caution due to the limited number of studies and differences in the interventions between the studies.

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

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