Glenohumeral corticosteroid injections in adhesive capsulitis: a systematic search and review

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.

Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

A flow diagram of study selection.

Figure 2

VAS improvements over time in corticosteroid injection groups. Image-guided injections are indicated with black lines and circle data points. (US = ultrasound, INJ = injection, PT = physical therapy) *Visual analog scale adjusted to a 0 to 10 scale where 0 represents “no pain” and 10 represents the “worst possible pain”

Figure 3

Abduction improvements over time in corticosteroid injection groups. Image-guided injections are indicated with black lines and circle data points. (CS = Corticosteroid injection; DIS = Distension; INJ = injection; MUA = manipulation under anesthesia; PT = physical therapy; US = ultrasound)