Abstract
Objective
To compare the efficacy of intra-articular (IA) steroid injection and distension in
patients with frozen shoulder.
Data Sources
Databases, including MEDLINE (via PubMed), Embase, Scopus, and Cochrane Library, were
searched for studies published up to November 2016.
Study Selection
We included all published randomized controlled trials (RCTs), quasi-experimental
studies, and observational studies investigating the effectiveness of IA steroid injection,
distension, and physiotherapy in patients with frozen shoulder. Sixteen RCTs and 1
observational study were enrolled in meta-analysis.
Data Extraction
Full texts were independently reviewed, and quality of RCTs was assessed with The
Cochrane Collaboration's tool. The primary outcome was functional improvement; the
secondary outcomes included pain reduction and external rotation (ER) improvement.
Data Synthesis
In pairwise meta-analysis, pooled standardized mean difference (SMD) of functional
improvement and pain reduction revealed equal efficacy at 3 follow-up time points.
With respect to ER improvement, distension has a superior effect compared with IA
steroid injection in the short term [(2–4wk; SMD, −.36; 95% confidence interval [CI],
−.68 to −.04) and medium term (6–16wk; SMD, −0.80; 95% CI, −1.32 to −0.29). The network
meta-analysis indicated a better efficacy for distension than for IA steroid injection
in ER improvement only in the medium term (6–16wk; SMD, −0.70; 95% CI, −1.19 to −0.21).
Conclusions
IA steroid injection was as effective as distension in shoulder function improvement,
pain reduction, and increasing ER of the shoulder. Distension yielded better ER improvement
in the medium term but to a minor extent in the long term. For patients with predominant
ER limitation, early distension could be considered the primary choice of treatment.
Keywords
List of abbreviations:
ER (external rotation), IA (intra-articular), PT (physiotherapy), RCT (randomized controlled trial), ROM (range of motion), SMD (standardized mean difference)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 09, 2017
Footnotes
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
