Systematic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy

Abstract

Objective: To review the efficacy of common interventions for shoulder pain. Design: All randomised controlled trials of non-steroidal anti-inflammatory drugs, intra-articular and subacromial glucocorticosteroid injection, oral glucocorticosteroid treatment, physiotherapy, manipulation under anaesthesia, hydrodilatation, and surgery for shoulder pain that were identified by computerised and hand searches of the literature and had a blinded assessment of outcome were included. Main outcome measures: Methodological quality (score out of 40), selection criteria, and outcome measures. Effect sizes were calculated and combined in a pooled analysis if study population, end point, and intervention were comparable. Results: Thirty one trials met inclusion criteria. Mean methodological quality score was 16.8 (9.5-22). Selection criteria varied widely, even for the same diagnostic label. There was no uniformity in the outcome measures used, and their measurement properties were rarely reported. Effect sizes for individual trials were small (range − 1.4 to 3.0). The results of only three studies investigating "rotator cuff tendinitis" could be pooled. The only positive finding was that subacromial steroid injection is better than placebo in improving the range of abduction (weighted difference between means 35°(95% confidence interval 14 to 55)). Conclusions: There is little evidence to support or refute the efficacy of common interventions for shoulder pain. As well as the need for further well designed clinical trials, more research is needed to establish a uniform method of defining shoulder disorders and developing outcome measures which are valid, reliable, and responsive in affected people.

Interobserver Reproducibility of the Visual Estimation of Range of Motion of the Shoulder

“…[1][2][3][4] The difference between the affected and the contralateral sides is related to the ability to perform the activities of daily life, such as dressing, washing, and lifting above shoulder level. [4][5][6] Measurement of the ROM plays a vital role in diagnosis, [7][8][9] assessment of the severity of disability, and the assessment of treatment outcome in clinical practice and research. 9 Several methods are available for quantifying ROM, such as goniometry, inclinometry, and even high-speed cinematography.…”

“…[4][5][6] Measurement of the ROM plays a vital role in diagnosis, [7][8][9] assessment of the severity of disability, and the assessment of treatment outcome in clinical practice and research. 9 Several methods are available for quantifying ROM, such as goniometry, inclinometry, and even high-speed cinematography. High reproducibility is an important prerequisite if measurements are to be useful for discriminative and evaluative purposes.…”

Therapeutic effects of hyaluronate injections in patients with chronic painful shoulder: A meta‐analysis of randomized controlled trials

“…Several systemic reviews have been conducted on the efficacy of corticosteroid injections into the shoulder (3)(4)(5)(6)(7)(8). Favorable outcomes with viscosupplementation of hyaluronate (HA) and its derivatives have been reported for pain and function associated with knee osteoarthritis (OA) (9), whereas few reports on the use of HA injections in the shoulder have been published (10,11).…”

Extracorporeal shock-wave therapy in the management of chronic soft-tissue conditions

“…A pre-assessment period helps to ensure that symptoms are stable, in order to exclude natural history as a source of improvement. [42][43][44] The use of different outcome measures can also prevent direct comparisons between studies. Measurement of different outcomes gives different and complementary information and all have a role to play in the evaluation of a treatment.…”