Systematic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy.
OBJECTIVE
To review the efficacy of common interventions for shoulder pain.


METHODS
All randomised controlled trials of non-steroidal anti-inflammatory drugs, intra-articular and subacromial glucocorticosteroid injection, oral glucocorticosteroid treatment, physiotherapy, manipulation under anaesthesia, hydrodilatation, and surgery for shoulder pain that were identified by computerised and hand searches of the literature and had a blinded assessment of outcome were included.


METHODS
Methodological quality (score out of 40), selection criteria, and outcome measures. Effect sizes were calculated and combined in a pooled analysis if study population, end point, and intervention were comparable.


RESULTS
Thirty one trials met inclusion criteria. Mean methodological quality score was 16.8 (9.5-22). Selection criteria varied widely, even for the same diagnostic label. There was no uniformity in the outcome measures used, and their measurement properties were rarely reported. Effect sizes for individual trials were small (range -1.4 to 3.0). The results of only three studies investigating "rotator cuff tendinitis" could be pooled. The only positive finding was that subacromial steroid injection is better than placebo in improving the range of abduction (weighted difference between means 35 degrees (95% confidence interval 14 to 55)).


CONCLUSIONS
There is little evidence to support or refute the efficacy of common interventions for shoulder pain. As well as the need for further well designed clinical trials, more research is needed to establish a uniform method of defining shoulder disorders and developing outcome measures which are valid, reliable, and responsive in affected people.
Green
S
S
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Buchbinder
R
R
Glazier
R
R
Forbes
A
A
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D006801:Humans; D007592:Joint Diseases / Q000188:drug therapy*; D010146:Pain / Q000517:prevention & control; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D012785:Shoulder Joint; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal