Frozen shoulder: the effectiveness of conservative and surgical interventions — systematic review
One article on PainSci cites Favejee 2011: Complete Guide to Frozen Shoulder
PainSci notes on Favejee 2011:
Does any therapeutic intervention restore motion and diminish pain in those who suffer from frozen shoulder? Researchers attempted to find this out by looking for systematic reviews and randomised clinical trials.
Five Chochrane reviews and 18 RCTs were looked at. This included looking at studies that studied the effectiveness of oral medication, injection therapy, physiotherapy, acupuncture, arthographic distension and suprascapular nerve block.
There was “strong evidence for the effectiveness of steroid injections and laser therapy in short-term and moderate evidence of steroid injections in mid-term follow-up.”
“Moderate evidence was found in favour of mobilisation techniques in the short and long term.”
The final conclusions of the researchers were: “For other commonly used interventions no or only limited evidence of effectiveness was found. Most of the included studies reported short-term results, whereas symptoms of frozen shoulder may last up to 4 years. High quality RCTs studying long-term results are clearly needed in this field.”
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
BACKGROUND: A variety of therapeutic interventions is available for restoring motion and diminishing pain in patients with frozen shoulder. An overview article concerning the evidence for the effectiveness of these interventions is lacking. Objective To provide an evidence-based overview regarding the effectiveness of conservative and surgical interventions to treat the frozen shoulder.
METHODS: The Cochrane Library, PubMed, Embase, Cinahl and Pedro were searched for relevant systematic reviews and randomised clinical trials (RCTs). Two reviewers independently selected relevant studies, assessed the methodological quality and extracted data. A best-evidence synthesis was used to summarise the results.
RESULTS: Five Cochrane reviews and 18 RCTs were included studying the effectiveness of oral medication, injection therapy, physiotherapy, acupuncture, arthrographic distension and suprascapular nerve block (SSNB).
CONCLUSIONS: We found strong evidence for the effectiveness of steroid injections and laser therapy in short-term and moderate evidence for steroid injections in mid-term follow-up. Moderate evidence was found in favour of mobilisation techniques in the short and long term, for the effectiveness of arthrographic distension alone and as an addition to active physiotherapy in the short term, for the effectiveness of oral steroids compared with no treatment or placebo in the short term, and for the effectiveness of SSNB compared with acupuncture, placebo or steroid injections. For other commonly used interventions no or only limited evidence of effectiveness was found. Most of the included studies reported short-term results, whereas symptoms of frozen shoulder may last up to 4 years. High quality RCTs studying long-term results are clearly needed in this field.
related content
- “Management of frozen shoulder: a systematic review and cost-effectiveness analysis,” Maund et al, Health Technol Assess, 2012.
- “Frozen shoulder: A systematic review of therapeutic options,” Uppal et al, World J Orthop, 2015.
- “Prognostic factors and therapeutic options for treatment of frozen shoulder: a systematic review,” Eljabu et al, Archives of Orthopaedic & Trauma Surgery, 2016.
- “Diagnosis and management of adhesive capsulitis,” Manske et al, Current Reviews In Musculoskeletal Medicine, 2008.
- “Shoulder adhesive capsulitis: systematic review of randomised trials using multiple corticosteroid injections,” Shah et al, Br J Gen Pract, 2007.
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