Efficacy of Pharmacological Therapies for Adhesive Capsulitis of the Shoulder: A Systematic Review and Network Meta-analysis

Abstract

Background: Several pharmacological interventions are used for the management of adhesive capsulitis of the shoulder, although the optimal treatment has yet to be defined. Purpose: To conduct a network meta-analysis to compare the effects of different pharmacological interventions for adhesive capsulitis, administered either alone or after distension of the shoulder capsule. Study Design: Network meta-analysis. Methods: The authors searched Scopus, PubMed, and the Cochrane Central Register of Controlled Trials up to April 22, 2018, for completed studies. They enrolled trials that assessed the results of different pharmacological treatments for the primary management of adhesive capsulitis. The primary outcome was pain relief as measured by self-administered questionnaires. The secondary outcome included the assessment of composite instruments that evaluated, at a minimum, pain and function. The authors clinically interpreted the results after back-transforming the standardized mean differences into mean differences in simple instruments and assessed the quality of the source studies using the Cochrane “risk of bias” tool. Results: The authors considered 30 trials with a total of 2010 participants in this systematic review. For pain relief, there was a significant difference in favor of intra-articular corticosteroids and distension of the shoulder capsule with steroids as compared with control in the short term (mean difference in visual analog scale (VAS): –1.4 [95% CI, −2.5 to −0.4] and −1.7 [95% CI, −3.2 to −0.1], respectively). Furthermore, rotator-interval injections were found to be superior to placebo (mean difference in VAS: –7.2; 95% CI, −10.1 to −4.4), although the intervention was considered in only 1 trial. Finally, there was a statistically significant difference in favor of multiple-site corticosteroid injections compared to placebo in both the short- (mean difference in Shoulder Pain and Disability Index [SPADI]: −86.7; 95% CI, −133.6 to −40) and intermediate-term assessment (mean difference in SPADI: −102.9; 95% CI, −163.9 to −41.8). Conclusion: Intra-articular corticosteroid intervention, administered either alone or after distension of the shoulder capsule, provided clinically meaningful improvements in the short term. Likewise, rotator-interval corticosteroid injections yielded promising results in terms of pain relief. However, these short-term benefits of steroids dissipated over time. Multiple-site corticosteroid injections showed clinical advantage over placebo for short- and intermediate-term composite outcome assessments.

Adhesive Capsulitis: Demographics and Predictive Factors for Success Following Steroid Injections and Surgical Intervention

“…The ideal number of glenohumeral corticosteroid injections for patients with adhesive capsulitis has not been well described. 8,19 A previous systematic review attempted to report on the benefit of multiple GH injections in patients with adhesive capsulitis. 19 Unfortunately, many of the included studies in this systematic review did not differentiate among one, two, and three injections but rather gave ranges for the number of injections.…”

“…Intraarticular corticosteroid injections have been shown to be effective in treating adhesive capsulitis, with improvements in pain and range of motion (ROM), whereas treatment with oral antiinflammatory medications has not generally produced effective results. 7,8 Glenohumeral hydrodilation has shown mixed results and as such is typically not a routine part of the treatment algorithm for adhesive capsulitis. 9,10 Because adhesive capsulitis often resolves without surgical intervention, a prolonged course of nonoperative management is offered in an attempt to avoid surgical intervention.…”

Functional improvement of bilateral frozen shoulder by unilateral intra-articular corticosteroid injection: a retrospective study

“…In shoulder pathologies such as FS or rotator cuff disease, intra-articular or periarticular corticosteroid injection is a method of choice among physicians because it rapidly reduces inflammation around the lesion in comparison with oral administration of corticosteroids and particularly acts locally, resulting in less severe systemic adverse effects. 24,25 In contrast to the expectation that a corticosteroid injection is locally acting, the corticosteroid is rapidly absorbed into the synovium after injection and thereafter induces systemic effects. 26,27 Moreover, several studies showed no significant difference in the improvement of shoulder pain between systemic corticosteroid injection and local corticosteroid injection; this occurred because the corticosteroid exerts its effect systemically rather than locally.…”

Superior Capsular Reconstruction of the Shoulder Using the Long Head of the Biceps Tendon: A Systematic Review of Surgical Techniques and Clinical Outcomes

“…When treated conservatively, persistent pain and RC arthropathy may develop. On the contrary, arthroscopic repair under tension yields disappointing results with a rate of structural failures of up to 94% [2,3]. Several surgical techniques have been proposed depending on the patients' age and the occurrence of accompanying arthritis [1].…”