Intra-Articular versus Subacromial Corticosteroid Injection for the Treatment of Adhesive Capsulitis: A Meta-Analysis and Systematic Review

Abstract

Background Adhesive capsulitis is one of the most well-known causes of pain and stiffness of the shoulder. Corticosteroid injections have been used for many years. However, it is still controversial where corticosteroid should be injected, whether subacromial or intra-articular. Objective The objective of this meta-analysis was to compare the effects of intra-articular (IA) and subacromial (SA) corticosteroid injections for the treatment of adhesive capsulitis. Materials and Methods Four foreign databases and two Chinese databases were searched for RCTs and quasi-RCTs involving the comparison of IA and SA corticosteroid injection for the treatment of adhesive capsulitis. The Cochrane risk of bias tool and PEDro score were used to evaluate the quality of the studies. The primary clinical outcomes including VAS, Constant score, ASES score, and ROM were collected. The secondary outcome of corticosteroid-related adverse reactions was also compared between the two groups. The results were evaluated and compared at five time points. Subgroup analyses were performed to further explore the differences between groups. Results Eight RCTs and one quasi-RCT, involving 512 participants, were identified and included in this meta-analysis. All studies were of low risk of bias and medium-high quality with the PEDro score ≥5 points. The pooled effect showed that there was no significant difference in the primary outcomes between IA injection and SA injection, with an exception of VAS at 2-3 weeks (P=0.02) and ROM of internal rotation at 8–12 weeks (P=0.02). According to the results of subgroup analyses, the differences of VAS and ROM of internal rotation did not last beyond the 2-3-week time period. Additionally, SA injection had the advantage of avoiding adverse reactions from the corticosteroid, especially in avoiding a large fluctuation of serum blood glucose levels. Conclusions When corticosteroid injection is used to treat adhesive capsulitis, both injection sites can be selected. However, due to the scarcity of related studies, more rigorous trials are needed to confirm the current findings.

Clinical Guidelines in the Management of Frozen Shoulder: An Update!

“…Steroid injection is certainly superior to PT in reducing pain but evidence is conflicting regarding restoration of ROM while comparing steroid injection with PT or MUA [46]. Furthermore, many issues regarding use of local injectable steroids such as optimal dose [52,53], single or multiple injection, site of injection (intraarticular/subacromial/rotator interval) [54,55], molecule (Triamcinolone/Methylprednisolone) [56][57][58], injection with or without imaging [59] remain contentious and are briefly mentioned in Table 1.…”

Optimizing Pain Control and Function in Patients With Adhesive Capsulitis by Choosing the Best Injection Site

“…1 Another meta-analysis and systematic review by Shang et al in 2019 also indicated better pain relief measured by VAS scores at 2 to 3 weeks following intra-articular Comparing Subacromial and Glenohumeral Injections injection compared to subacromial injection (P=0.02). 11 In this review, the corticosteroid selected in 5 studies was 1 mL 40 mg/mL triamcinolone, while 4 studies used 1 mL 40 mg/mL methylprednisolone acetate. In all but 1 study, lidocaine 1% to 2% was mixed with the corticosteroid, with a total volume of 1 to 10 mL injected.…”

Frozen Shoulder: Overview of Clinical Presentation and Review of the Current Evidence Base for Management Strategies

“…Ultrasound-guided injections may be preferred because injections without radiological guidance have a high incidence of not entering the glenohumeral joint [40,41]. However, recent evidence also suggests there may be no significant difference in outcomes between subacromial and glenohumeral injection [42,43].…”