Shoulder adhesive capsulitis: systematic review of randomised trials using multiple corticosteroid injections.
BACKGROUND
Adhesive capsulitis is a common, painful, and disabling condition that has been managed with corticosteroid injections for over 50 years. There is debate over the use of single or multiple injections, but no systematic review has investigated the effects of administering multiple injections.


OBJECTIVE
To assess the efficacy of treating adhesive capsulitis of the shoulder with multiple corticosteroid injections.


METHODS
Systematic review.


METHODS
An English language search for randomised controlled trials was conducted from: MEDLINE, EMBASE, CINAHL, PEDro, SIGLE, National Technical Information Service, British National Bibliography, Index of Scientific and Technical Proceedings databases, and the Cochrane Library. Randomised controlled trials were identified from reference lists of review and eligible articles. The studies were assessed using a recognised rating system of methodological trial quality. The conclusions and results of the identified studies, based on their main outcome measures, were then summarised.


RESULTS
Nine randomised controlled trials were identified and four studies were rated as high quality. Three high quality studies showed a beneficial effect for the use of multiple corticosteroid injections with outcome measures of pain reduction, improved function, and increased range of shoulder movement.


CONCLUSIONS
The evidence suggested that multiple injections were beneficial until 16 weeks from the date of the first injection. Up to three injections were beneficial, with limited evidence that four to six injections were beneficial. No evidence was found to support giving more than six injections.
Shah
Nicholas
N
Whetstone Medical Centre, Birkenhead. nickshah@nhs.net
Lewis
Mark
M
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D002062:Bursitis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007270:Injections, Intra-Articular; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular / Q000502:physiology; D012785:Shoulder Joint / Q000503:physiopathology; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones
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