Glenohumeral Corticosteroid Injections in Adhesive Capsulitis: A Systematic Search and Review. Issue 12 (1st July 2014)

• Record Type: Journal Article
• Authors: Song, Amos; Higgins, Laurence D.; Newman, Joel; Jain, Nitin B.
• Is Part Of: PM&R. Volume 6:Issue 12(2014)
• Page Start: 1143
• Page End: 1156
• Publication Date: 2014-07-01
• Subjects: Medical rehabilitation -- Periodicals; Physical therapy -- Periodicals; Physical Therapy Modalities -- Periodicals; 615.5
• DOI: 10.1016/j.pmrj.2014.06.015
• Languages: English
• ISSNs: 1934-1482

Abstract

Abstract : Objective: To assess the literature on outcomes of corticosteroid injections for adhesive capsulitis, and, in particular, image‐guided corticosteroid injections. Type: Systematic search and review. Literature Survey: The databases used were PubMed (1966‐present), EMBASE (1947‐present), Web of Science (1900‐present), and the Cochrane Central Register of Controlled Trials. Upon reviewing full‐text articles of these studies, a total of 25 studies were identified for inclusion. The final yield included 7 prospective studies, 16 randomized trials, and 2 retrospective studies. Methodology: This systematic review was formatted by using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Study criteria were limited to clinical trials, prospective studies, and retrospective studies that specifically evaluated intra‐articular corticosteroid injections, both alone and in combination with other treatment modalities, for shoulder adhesive capsulitis. We included studies that were not randomized control trials because our review was not a meta‐analysis. Data items extracted from each study included the following: study design, study population, mean patient age, duration of study, duration of symptoms, intervention, single or multiple injections, location of injections, control population, follow‐up duration, and outcome measurements. A percentage change in outcome measurements was calculated when corresponding data were available. Risk of bias in individual studies was assessed when appropriate. Synthesis: All the studies involved at least 1 corticosteroid injection intended for placement in the glenohumeral joint, but only 8 studies used image guidance for all injections. Seven of these studies reported statistically significant improvements in range of motion at or before 12 weeks of follow‐up. Ninety‐two percent of all the studies documented a greater improvement in either visual analog pain scores or range of motion after corticosteroid injections in the first 1‐6 weeks compared with the control or comparison group. Conclusions: Corticosteroid injections offer rapid pain relief in the short‐term (particularly in the first 6 weeks) for adhesive capsulitis. Long‐term outcomes seem to be similar to other treatments, including placebo. The added benefit of image‐guided corticosteroid injections in improving shoulder outcomes needs further assessment.