Abstract
Background Adhesive capsulitis is one of the most well-known causes of pain and stiffness of the shoulder. Corticosteroid injections have been used for many years. However, it is still controversial where corticosteroid should be injected, whether subacromial or intra-articular. Objective The objective of this meta-analysis was to compare the effects of intra-articular (IA) and subacromial (SA) corticosteroid injections for the treatment of adhesive capsulitis. Materials and Methods Four foreign databases and two Chinese databases were searched for RCTs and quasi-RCTs involving the comparison of IA and SA corticosteroid injection for the treatment of adhesive capsulitis. The Cochrane risk of bias tool and PEDro score were used to evaluate the quality of the studies. The primary clinical outcomes including VAS, Constant score, ASES score, and ROM were collected. The secondary outcome of corticosteroid-related adverse reactions was also compared between the two groups. The results were evaluated and compared at five time points. Subgroup analyses were performed to further explore the differences between groups. Results Eight RCTs and one quasi-RCT, involving 512 participants, were identified and included in this meta-analysis. All studies were of low risk of bias and medium-high quality with the PEDro score ≥5 points. The pooled effect showed that there was no significant difference in the primary outcomes between IA injection and SA injection, with an exception of VAS at 2-3 weeks (P=0.02) and ROM of internal rotation at 8–12 weeks (P=0.02). According to the results of subgroup analyses, the differences of VAS and ROM of internal rotation did not last beyond the 2-3-week time period. Additionally, SA injection had the advantage of avoiding adverse reactions from the corticosteroid, especially in avoiding a large fluctuation of serum blood glucose levels. Conclusions When corticosteroid injection is used to treat adhesive capsulitis, both injection sites can be selected. However, due to the scarcity of related studies, more rigorous trials are needed to confirm the current findings.
Highlights
Adhesive capsulitis of the shoulder, clinically known as “frozen shoulder,” is one of the most well-known causes of pain and stiffness of the shoulder; it usually affects people over the age of 50 years old and is known as “50 shoulder” in China [1]
A total of 2236 studies were identified from the initial electronic search, of which 197 studies were obtained from the Chinese databases
Upon further scrutiny of the 55 remaining studies, 46 studies were excluded according to the inclusion criteria and exclusion criteria: the control groups of 26 studies did not meet the inclusion criteria, 17 studies were basic science studies of adhesive capsulitis, 1 study had incomplete data, and 2 studies were letters with comments
Summary
Adhesive capsulitis of the shoulder, clinically known as “frozen shoulder,” is one of the most well-known causes of pain and stiffness of the shoulder; it usually affects people over the age of 50 years old and is known as “50 shoulder” in China [1]. E objective of this meta-analysis was to compare the effects of intra-articular (IA) and subacromial (SA) corticosteroid injections for the treatment of adhesive capsulitis. Four foreign databases and two Chinese databases were searched for RCTs and quasi-RCTs involving the comparison of IA and SA corticosteroid injection for the treatment of adhesive capsulitis. E secondary outcome of corticosteroid-related adverse reactions was compared between the two groups. E pooled effect showed that there was no significant difference in the primary outcomes between IA injection and SA injection, with an exception of VAS at 2-3 weeks (P 0.02) and ROM of internal rotation at 8–12 weeks (P 0.02). According to the results of subgroup analyses, the differences of VAS and ROM of internal rotation did not last beyond the 2-3-week time period. Due to the scarcity of related studies, more rigorous trials are needed to confirm the current findings
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