A Cochrane review [Abstract] 1 included 14 studies with a total of about 700 patients with adhesive capsulitis of the shoulder. Two trials comparing intra-articular steroid alone or in combination with subacromial steroid injection to placebo or no treatment suggested a possible early benefit and none of the trials demonstrated any longer term benefit. In one trial (n=109) comparing intra-articular steroid injection to physiotherapy all outcomes measured at three and seven weeks favoured steroid injection (RR for treatment success with steroid injection at 7 weeks 1.66, 95% CI 1.21 to 2.28). No difference was demonstrated for any of the measured outcomes at 26 weeks. Results of other 2 trials comparing intra-articular steroid injection to physiotherapy were inconclusive. No difference with respect to pain was demonstrated between intra-articular steroid injection versus physiotherapy and NSAID at two and 12 weeks following treatment (1 trial, n=20). One trial (n=24) demonstrated no difference with respect to range of abduction at four months between participants who had received an intra-articular injection of steroid with manipulation under anaesthesia compared to those who had manipulation under anaesthesia alone.
A systematic review 2 including 9 RCTs on the efficacy of multiple corticosteroid injections for adhesive capsulitis, with a total of 476 subjects, was abstracted in DARE. Four high-quality studies (n=220) found that multiple steroid injections resulted in reduced pain and/or improved movement (external rotation) from 4 to 16 weeks. Three studies found evidence that treatment with up to three corticosteroid injections was beneficial, while one found that up to six injections was beneficial. Adverse reactions related to corticosteroid injections included pain after injection (10 to 44%), facial flushing (12.5 to 20%), rash (4%) and irregular menstrual bleeding (10.5%).
Comment: The quality of evidence is downgraded by limitations in study quality, by inconsistency (variability in results across studies, heterogeneity in interventions and outcomes) and by imprecise results (limited study size for each comparison).
Primary/Secondary Keywords