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Glenohumeral Corticosteroid Injections in Adhesive Capsulitis: A Systematic Search and Review
Author(s) -
Song Amos,
Higgins Laurence D.,
Newman Joel,
Jain Nitin B.
Publication year - 2014
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1016/j.pmrj.2014.06.015
Subject(s) - medicine , capsulitis , meta analysis , randomized controlled trial , population , corticosteroid , systematic review , clinical trial , inclusion and exclusion criteria , medline , physical therapy , surgery , range of motion , alternative medicine , pathology , environmental health , political science , law
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.