Abstract
The objective was to explore the effectiveness of glenohumeral joint distension for the treatment of frozen shoulder. We searched electronic data sources including PubMed, Scopus, and Embase from the earliest records available to February 2017. Eleven randomized controlled trials including at least one pair of comparisons between capsular distension and a reference treatment were included, comprising 747 participants. Patients’ characteristics, details of reference treatments, aspects of capsular distension therapy, and outcome measurement were evaluated at three points in time: baseline, early following intervention, and at the trial’s end. The primary and secondary outcomes were the between-group standardized mean differences of changes in shoulder function and range of motion, respectively. Regarding the long-term primary outcome, the superiority of capsular distension to reference treatments was not identified. One secondary outcome (external rotation limitation) showed a probable early positive response to capsular distension when compared to intra-articular corticosteroid injection. Aspects of approaches, imaging guiding techniques and doses of distension were not found to modify treatment effectiveness. In conclusion, distension of the glenohumeral joint provides a similar long-term efficacy to all reference treatments. A single dose of a corticosteroid-contained regimen introduced through the ultrasound-guided posterior approach is a preferable practice of capsular distension for the management of frozen shoulder.
Highlights
MethodsWe included randomized controlled trials (RCTs) that investigated the effectiveness of capsular distension for treating frozen shoulder
Ten studies were further excluded because one was a pilot research aiming at determining the maximal volume of hydrodilatation before capsule rupturing[15]; one was an experimental study comparing the effectiveness of hydrodilatation with capsule preservation and that with capsule rupturing[5]; three were case studies investigating pain reduction before and after hydrodilatation[6, 16, 17]; two were non-randomized comparative studies comparing arthrography with intra-articular corticosteroid and with or without capsular distension[18, 19]; one was an randomized controlled trials (RCTs) comparing hydrodilatation by using two different guiding
In terms of shoulder function, there was no significant benefit of capsular distension over intra-articular corticosteroid injection early following intervention (SMD, 0.51; 95% confidence intervals (CIs), −0.13 to 1.15) and at the end of the trial (SMD, 0.21; 95% CI, −011 to 0.52) (Fig. 3)
Summary
We included randomized controlled trials (RCTs) that investigated the effectiveness of capsular distension for treating frozen shoulder. The following were extracted from each of the chosen studies: author name, year of publication, study type, demography of the participants, definition of frozen shoulder, allocation of the recruits, in formation on the randomization process used, dose and regimen for capsular distension, information on the imaging modality used for guiding injections, details of the controlled treatment and outcome measurements taken before and after interventions. The quality of each selected study was assessed using the Cochrane Collaboration tool for assessing risk of bias, which evaluates random sequence generation, allocation concealment, blinding of the participants, blinding of the outcome assessment, completeness of outcome data, reporting selectiveness and other bias[11] All of these items were judged as either a high, low, or unclear risk of bias of the study’s design. All of the calculations were conducted using Comprehensive Meta-analysis Software version 3 (Biostat, Englewood, NJ, USA), with p < 0.05 considered to be of statistical significance
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