title: Steroid Injection Versus Physiotherapy for Patients With Adhesive Capsulitis of the Shoulder: A PRIMSA Systematic Review and Meta-Analysis of Randomized Controlled Trials.
abstract: To compare the effect of steroid injection and physiotherapy for patients with adhesive capsulitis of the shoulder (ACS).An electronic search was performed on Pubmed, Embase, and Cochrane library, and reference lists were also reviewed for randomized controlled trials (RCTs) comparing steroid injection and physiotherapy for patients with ACS. The quality of included studies were assessed using PEDro scale. Standardized mean differences (SMDs) and 95% confidence interval (CI) were used for comparisons. The primary outcome was functional improvement.Nine RCTs including 453 patients were identified. From 6-7 weeks to 24-26 weeks postintervention, no superiority was noted in favor of either steroid injection or physiotherapy for functional improvement (SMD 0.28; 95% CI -0.01-0.58; P = 0.06) or pain relief (SMD -0.10; 95% CI -0.70-0.50; P = 0.75). Steroid injection provided more improvement in passive external rotation at 24 to 26 weeks (3 studies, SMD 0.42; 95% CI 0.11-0.72; P = 0.007) but not at 6 to 7 weeks (4 studies, SMD 0.63; 95% CI 0.36-0.89; P = 0.32) or 12 to 16 weeks (3 studies, SMD -0.07; 95% CI -0.79-0.65; P = 0.85). Steroid injection was as safe as physiotherapy for patients with ACS (risk ratio 0.94; 95% CI 0.67-1.31).Both steroid injection and physiotherapy are equally effective for patients with ACS. One steroid injection might be the 1st choice for ACS. Results should be interpreted with caution due to the heterogeneity among the studies.
authors.affiliation: From the Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai (YS, PZ, JC); and Department of Cardiology, Union Hospital, Huazhong University of Science and Technology, Wuhan, People's Republic of China (SL, ZW).
authors.forename: Yaying
authors.initials: Y
authors.lastname: Sun
authors.forename: Shuai
authors.initials: S
authors.lastname: Lu
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Wang
authors.forename: Jiwu
authors.initials: J
authors.lastname: Chen
mesh_terms: D002062:Bursitis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D004185:Disability Evaluation; D006801:Humans; D007270:Injections, Intra-Articular; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D012785:Shoulder Joint; D020069:Shoulder Pain / Q000209:etiology; D013256:Steroids / Q000008:administration & dosage*
chemical_list: D013256:Steroids