A Cochrane review (abstract , review [Abstract]) included 26 studies with a median sample size of 48 patients. Exercise was demonstrated to be effective in terms of short term recovery in rotator cuff disease (RR 7.74, 95% CI 1.97-30.32), and longer term benefit with respect to function (RR 2.45, 95% CI 1.24-4.86). Combining mobilisation with exercise resulted in additional benefit when compared to exercise alone for rotator cuff disease. Laser therapy was demonstrated to be more effective than placebo (RR 3.71, 95% CI 1.89-7.28) for adhesive capsulitis but not for rotator cuff tendinitis. Both ultrasound and pulsed electromagnetic field therapy resulted in improvement compared to placebo in pain in calcific tendinitis (RR 1.81, 95% CI 1.26-2.60 and RR 19, 95% CI 1.16-12.43) respectively). There is no evidence of the effect of ultrasound in shoulder pain (mixed diagnosis), adhesive capsulitis or rotator cuff tendinitis. When compared to exercises, ultrasound is of no additional benefit over and above exercise alone. There is some evidence that for rotator cuff disease, corticosteroid injections are superior to physiotherapy and no evidence that physiotherapy alone is of benefit for adhesive capsulitis.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment) and by imprecise results (few patients and wide confidence intervals).
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