title: Glenohumeral corticosteroid injections in adhesive capsulitis: a systematic search and review.
abstract: OBJECTIVE
  To assess the literature on outcomes of corticosteroid injections for adhesive capsulitis, and, in particular, image-guided corticosteroid injections. TYPE: Systematic search and review.
  
  
  METHODS
  The databases used were PubMed (1966-present), EMBASE (1947-present), Web of Science (1900-present), and the Cochrane Central Register of Controlled Trials. Upon reviewing full-text articles of these studies, a total of 25 studies were identified for inclusion. The final yield included 7 prospective studies, 16 randomized trials, and 2 retrospective studies.
  
  
  METHODS
  This systematic review was formatted by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study criteria were limited to clinical trials, prospective studies, and retrospective studies that specifically evaluated intra-articular corticosteroid injections, both alone and in combination with other treatment modalities, for shoulder adhesive capsulitis. We included studies that were not randomized control trials because our review was not a meta-analysis. Data items extracted from each study included the following: study design, study population, mean patient age, duration of study, duration of symptoms, intervention, single or multiple injections, location of injections, control population, follow-up duration, and outcome measurements. A percentage change in outcome measurements was calculated when corresponding data were available. Risk of bias in individual studies was assessed when appropriate.
  
  
  RESULTS
  All the studies involved at least 1 corticosteroid injection intended for placement in the glenohumeral joint, but only 8 studies used image guidance for all injections. Seven of these studies reported statistically significant improvements in range of motion at or before 12 weeks of follow-up. Ninety-two percent of all the studies documented a greater improvement in either visual analog pain scores or range of motion after corticosteroid injections in the first 1-6 weeks compared with the control or comparison group.
  
  
  CONCLUSIONS
  Corticosteroid injections offer rapid pain relief in the short-term (particularly in the first 6 weeks) for adhesive capsulitis. Long-term outcomes seem to be similar to other treatments, including placebo. The added benefit of image-guided corticosteroid injections in improving shoulder outcomes needs further assessment.
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Graduate Medical Sciences, Boston University School of Medicine, Boston, MA(∗). Electronic address: nitin.jain@vanderbilt.edu.
authors.forename: Amos
authors.initials: A
authors.lastname: Song
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Harvard Shoulder Service, Harvard Medical School, Boston, MA(†).
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Higgins
authors.affiliation: Department of Radiology, New England Baptist Hospital, Boston, MA(‡).
authors.forename: Joel
authors.initials: J
authors.lastname: Newman
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Harvard Shoulder Service, Harvard Medical School, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA; Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN(§).
authors.forename: Nitin B
authors.initials: NB
authors.lastname: Jain
mesh_terms: D002062:Bursitis / Q000188:drug therapy* / Q000503:physiopathology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007270:Injections, Intra-Articular; D016059:Range of Motion, Articular / Q000502:physiology; D012785:Shoulder Joint
chemical_list: D005938:Glucocorticoids