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Comparative Efficacy of Intra-Articular Steroid Injection and Distension in Patients With Frozen Shoulder: A Systematic Review and Network Meta-Analysis

  • Meng-Ting Lin
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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  • Ming-Yen Hsiao
    Correspondence
    Corresponding author Ming-Yen Hsiao, MD, Departments of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, No 7, Zhongshan S Rd, Taipei 100, Taiwan.
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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  • Yu-Kang Tu
    Affiliations
    Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
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  • Tyng-Guey Wang
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Published:September 09, 2017DOI:https://doi.org/10.1016/j.apmr.2017.08.471

      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)
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      References

        • Anton H.A.
        Frozen shoulder.
        Can Fam Physician. 1993; 39: 1773-1778
        • van der Windt D.A.
        • Koes B.W.
        • de Jong B.A.
        • Bouter L.M.
        Shoulder disorders in general practice: incidence, patient characteristics, and management.
        Ann Rheum Dis. 1995; 54: 959-964
        • Dias R.
        • Cutts S.
        • Massoud S.
        Frozen shoulder.
        BMJ. 2005; 331: 1453-1456
        • Neviaser A.S.
        • Hannafin J.A.
        Adhesive capsulitis.
        Am J Sports Med. 2010; 38: 2346-2356
        • Favejee M.M.
        • Huisstede B.M.
        • Koes B.W.
        Frozen shoulder: the effectiveness of conservative and surgical interventions - systematic review.
        Br J Sports Med. 2011; 45: 49-56
        • Buchbinder R.
        • Green S.
        • Youd J.M.
        Corticosteroid injections for shoulder pain.
        Cochrane Database Syst Rev. 2003; : CD004016
        • Lorbach O.
        • Anagnostakos K.
        • Scherf C.
        • Seil R.
        • Kohn D.
        • Pape D.
        Nonoperative management of adhesive capsulitis of the shoulder: oral cortisone application versus intra-articular cortisone injections.
        J Shoulder Elbow Surg. 2010; 19: 172-179
        • Sun Y.
        • Lu S.
        • Zhang P.
        • Wang Z.
        • Chen J.
        Steroid injection versus physiotherapy for patients with adhesive capsulitis of the shoulder: a PRIMSA systematic review and meta-analysis of randomized controlled trials.
        Medicine (Baltimore). 2016; 95: e3469
        • Gavant M.L.
        • Rizk T.E.
        • Gold R.E.
        • Flick P.A.
        Distention arthrography in the treatment of adhesive capsulitis of the shoulder.
        J Vasc Interv Radiol. 1994; 5: 305-308
        • Buchbinder R.
        • Green S.
        • Forbes A.
        • Hall S.
        • Lawler G.
        Arthrographic joint distension with saline and steroid improves function and reduces pain in patients with painful stiff shoulder: results of a randomised, double blind, placebo controlled trial.
        Ann Rheum Dis. 2004; 63: 302-309
        • Buchbinder R.
        • Green S.
        • Youd J.M.
        • Johnston R.V.
        • Cumpston M.
        Arthrographic distension for adhesive capsulitis (frozen shoulder).
        Cochrane Database Syst Rev. 2008; : CD007005
        • Park G.Y.
        • Hwnag S.E.
        Comparison of intraarticular steroid injection with and without capsular distension in adhesive capsulitis of the shoulder.
        J Korean Acad Rehabil Med. 2000; 24: 1174-1179
        • Tveitå E.K.
        • Tariq R.
        • Sesseng S.
        • Juel N.G.
        • Bautz-Holter E.
        Hydrodilatation, corticosteroids and adhesive capsulitis: a randomized controlled trial.
        BMC Musculoskelet Disord. 2008; 9: 53
        • Sharma S.P.
        • Bærheim A.
        • Moe-Nilssen R.
        • Kvåle A.
        Adhesive capsulitis of the shoulder, treatment with corticosteroid, corticosteroid with distension or treatment-as-usual: a randomised controlled trial in primary care.
        BMC Musculoskelet Disord. 2016; 17: 232
        • Yoon J.P.
        • Chung S.W.
        • Kim J.E.
        • et al.
        Intra-articular injection, subacromial injection, and hydrodilatation for primary frozen shoulder: a randomized clinical trial.
        J Shoulder Elbow Surg. 2016; 25: 376-383
        • Ahn J.K.
        • Kim J.
        • Lee S.J.
        Effects of ultrasound-guided intra-articular ketorolac injection with capsular distension.
        J Back Musculoskelet Rehabil. 2015; 28: 497-503
        • Park K.D.
        • Nam H.S.
        • Lee J.K.
        • Kim Y.J.
        • Park Y.
        Treatment effects of ultrasound-guided capsular distension with hyaluronic acid in adhesive capsulitis of the shoulder.
        Arch Phys Med Rehabil. 2013; 94: 264-270
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • PRISMA Group
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Ann Intern Med. 2009; 151: 264-269
        • Asuman D.
        • Refika D.
        • Neşe Ö
        Intraarticular hydraulic distension with steroids in the management of hemiplegic shoulder.
        Turk J Med Sci. 2013; 43: 304-310
      1. Higgins J.P.T. Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011 (Available from www.cochrane-handbook.org)
        • Stang A.
        Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.
        Eur J Epidemiol. 2010; 25: 603-605
        • Hsiao M.Y.
        • Hung C.Y.
        • Chang K.V.
        • Chien K.L.
        • Tu Y.K.
        • Wang T.G.
        Comparative effectiveness of autologous blood-derived products, shock-wave therapy and corticosteroids for treatment of plantar fasciitis: a network meta-analysis.
        Rheumatology (Oxford). 2015; 54: 1735-1743
        • Fleiss J.L.
        The statistical basis of meta-analysis.
        Stat Methods Med Res. 1993; 2: 121-145
        • White I.R.
        Network meta-analysis.
        The Stata Journal. 2015; 15: 951-985
        • Tu Y.K.
        Node-splitting generalized linear mixed models for evaluation of inconsistency in network meta-analysis.
        Value Health. 2016; 19: 957-963
        • Tu Y.K.
        Using generalized linear mixed models to evaluate inconsistency within a network meta-analysis.
        Value Health. 2015; 18: 1120-1125
        • Kim K.
        • Lee K.J.
        • Kim H.C.
        • Lee K.J.
        • Kim D.K.
        • Chung S.G.
        Capsule preservation improves short-term outcome of hydraulic distension in painful stiff shoulder.
        J Orthop Res. 2011; 29: 1688-1694
        • Park K.D.
        • Nam H.S.
        • Kim T.K.
        • Kang S.H.
        • Lim M.H.
        • Park Y.
        Comparison of sono-guided capsular distension with fluoroscopically capsular distension in adhesive capsulitis of shoulder.
        Ann Rehabil Med. 2012; 36: 88-97
        • Bae J.H.
        • Park Y.S.
        • Chang H.J.
        • et al.
        Randomized controlled trial for efficacy of capsular distension for adhesive capsulitis: fluoroscopy-guided anterior versus ultrasonography-guided posterolateral approach.
        Ann Rehabil Med. 2014; 38: 360-368
        • Lee J.H.
        • Kim S.B.
        • Lee K.W.
        • Lee S.J.
        • Lee J.U.
        Effect of hypertonic saline in intra-articular hydraulic distension for adhesive capsulitis.
        PM R. 2015; 7: 721-726
        • Khan A.A.
        • Mowla A.
        • Shakoor M.A.
        • Rahman M.R.
        Arthrographic distension of the shoulder joint in the management of frozen shoulder.
        Mymensingh Med J. 2005; 14: 67-70
        • Buchbinder R.
        • Youd J.M.
        • Green S.
        • et al.
        Efficacy and cost-effectiveness of physiotherapy following glenohumeral joint distension for adhesive capsulitis: a randomized trial.
        Arthritis Rheum. 2007; 57: 1027-1037
        • Jacobs L.G.
        • Smith M.G.
        • Khan S.A.
        • Smith K.
        • Joshi M.
        Manipulation or intra-articular steroids in the management of adhesive capsulitis of the shoulder? A prospective randomized trial.
        J Shoulder Elbow Surg. 2009; 18: 348-353
        • Kwak K.I.
        • Kim E.K.
        The clinical effect of hydraulic distension plus manual therapy on patients with frozen shoulder.
        J Phys Ther Sci. 2016; 28: 2393-2396
        • Elleuch M.H.
        • Yahia A.
        • Ghroubi S.
        • Kharrat O.
        • Mezghanni M.
        • Ayedi K.
        The contribution of capsular distension to the treatment of primary adhesive capsulitis of the shoulder: a comparative study versus rehabilitation.
        Ann Readapt Med Phys. 2008; 51: 722-728
        • Mun S.W.
        • Baek C.H.
        Clinical efficacy of hydrodistention with joint manipulation under interscalene block compared with intra-articular corticosteroid injection for frozen shoulder: a prospective randomized controlled study.
        J Shoulder Elbow Surg. 2016; 25: 1937-1943
        • Saeidian S.R.
        • Forough B.
        • Hemmat A.A.
        • Tahmasebi M.
        Treatment of frozen shoulder: a double blind study comparing the impact of triamcinolone injection alone or in association with joint distention.
        Res J Pharm Biol Chem Sci. 2013; 4: 226-234
        • Gam A.N.
        • Schydlowsky P.
        • Rossel I.
        • Remvig L.
        • Jensen E.M.
        Treatment of “frozen shoulder” with distension and glucorticoid compared with glucorticoid alone. A randomised controlled trial.
        Scand J Rheumatol. 1998; 27: 425-430
        • Jacobs L.G.
        • Barton M.A.
        • Wallace W.A.
        • Ferrousis J.
        • Dunn N.A.
        • Bossingham D.H.
        Intra-articular distension and steroids in the management of capsulitis of the shoulder.
        BMJ. 1991; 302: 1498-1501
        • Park S.W.
        • Lee H.S.
        • Kim J.H.
        The effectiveness of intensive mobilization techniques combined with capsular distension for adhesive capsulitis of the shoulder.
        J Phys Ther Sci. 2014; 26: 1767-1770
        • Maryam M.
        • Zahra K.
        • Adeleh B.
        • Morteza Y.
        Comparison of corticosteroid injections, physiotherapy, and combination therapy in treatment of frozen shoulder.
        Pakistan J Med Sci. 2012; 28: 648-651
        • Calis M.
        • Demir H.
        • Ulker S.
        • Kirnap M.
        • Duygulu F.
        • Calis H.T.
        Is intraarticular sodium hyaluronate injection an alternative treatment in patients with adhesive capsulitis?.
        Rheumatol Int. 2006; 26: 536-540
        • Ryans I.
        • Montgomery A.
        • Galway R.
        • Kernohan W.G.
        • McKane R.
        A randomized controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis.
        Rheumatology (Oxford). 2005; 44: 529-535
        • Carette S.
        • Moffet H.
        • Tardif J.
        • et al.
        Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial.
        Arthritis Rheum. 2003; 48: 829-838
        • Arslan S.
        • Celiker R.
        Comparison of the efficacy of local corticosteroid injection and physical therapy for the treatment of adhesive capsulitis.
        Rheum Int. 2001; 21: 20-23
        • van der Windt D.A.
        • Koes B.W.
        • Devillé W.
        • Boeke A.J.
        • de Jong B.A.
        • Bouter L.M.
        Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care: randomised trial.
        BMJ. 1998; 317: 1292-1296
        • Dacre J.E.
        • Beeney N.
        • Scott D.L.
        Injections and physiotherapy for the painful stiff shoulder.
        Ann Rheum Dis. 1989; 48: 322-325
        • Corbeil V.
        • Dussault R.G.
        • Leduc B.E.
        • Fleury J.
        Adhesive capsulitis of the shoulder: a comparative study of arthrography with intra-articular corticotherapy and with or without capsular distension.
        Can Assoc Radiol J. 1992; 43: 127-130
        • Yoon S.H.
        • Lee H.Y.
        • Lee H.J.
        • Kwack K.S.
        Optimal dose of intra-articular corticosteroids for adhesive capsulitis: a randomized, triple-blind, placebo-controlled trial.
        Am J Sports Med. 2013; 41: 1133-1139
        • de Jong B.A.
        • Dahmen R.
        • Hogeweg J.A.
        • Marti R.K.
        Intra-articular triamcinolone acetonide injection in patients with capsulitis of the shoulder: a comparative study of two dose regimens.
        Clin Rehabil. 1998; 12: 211-215
        • Lee L.C.
        • Lieu F.K.
        • Lee H.L.
        • Tung T.H.
        Effectiveness of hyaluronic acid administration in treating adhesive capsulitis of the shoulder: a systematic review of randomized controlled trials.
        Biomed Res Int. 2015; 2015: 314120
        • Shah N.
        • Lewis M.
        Shoulder adhesive capsulitis: systematic review of randomised trials using multiple corticosteroid injections.
        Br J Gen Pract. 2007; 57: 662
        • Bloom J.E.
        • Rischin A.
        • Johnston R.V.
        • Buchbinder R.
        Image-guided versus blind glucocorticoid injection for shoulder pain.
        Cochrane Database Syst Rev. 2012; : CD009147