Skip to main content

Advertisement

Log in

Hydrodilatation with corticosteroids is the most effective conservative management for frozen shoulder

  • SHOULDER
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this overview is to summarise the findings of meta-analyses of randomised controlled trials that compare conservative treatment options for frozen shoulder.

Methods

The authors conducted an electronic literature search for meta-analyses published using PubMed, Web of Science and the Cochrane Library. Two researchers independently applied selection criteria and assessed quality of meta-analyses using A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). Short-, medium- and long-term outcomes were synthesised narratively.

Results

A total of 319 studies were identified, of which 8 meta-analyses were eligible for inclusion. All included meta-analyses were judged to be low or critically low quality according to AMSTAR-2, however, their data synthesis and interpretation was considered valid. Physiotherapy, intra-articular and subacromial corticosteroid injection (CSI), and arthrographic distension/hydrodilatation with corticosteroid were reported with sufficient evidence. Intra-articular CSI and arthrographic distension/hydrodilatation with corticosteroid provide advantages over placebo in short-term pain relief, range of motion (ROM) and shoulder function, with improvements in ROM continuing into the medium and long term. Arthrographic distension/hydrodilatation with corticosteroid provides medium-term and long-term improvements in ROM over intra-articular CSI and physiotherapy. Proprioceptive neuromuscular facilitation provides advantages over conventional physiotherapy for pain improvement and external rotation in the short term.

Conclusions

Arthrographic distension/hydrodilatation with corticosteroid provides superior pain relief in the short term and improvement in range of motion across all time frames for frozen shoulder when compared to CSI or physiotherapy.

Level of evidence

Level IV

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Abrassart S, Kolo F, Piotton S, Chih-Hao Chiu J, Stirling P et al (2020) ‘Frozen shoulder’ is ill-defined. How can it be described better? EFORT Open Rev 5:273–279

    PubMed  PubMed Central  Google Scholar 

  2. Blanchard V, Barr S, Cerisola FL (2010) The effectiveness of corticosteroid injections compared with physiotherapeutic interventions for adhesive capsulitis: a systematic review. Physiotherapy 96(2):95–107

    PubMed  Google Scholar 

  3. Boutefnouchet T, Jordan R, Bhabra G, Modi C, Saithna A (2019) Comparison of outcomes following arthroscopic capsular release for idiopathic, diabetic and secondary shoulder adhesive capsulitis: A Systematic Review. OrthopTraumatolSurg Res 105(5):839–846

    Google Scholar 

  4. Buchbinder R, Green S, Youd JM, Johnston RV (2006) Oral steroids for adhesive capsulitis. CD 18(4):006189

    Google Scholar 

  5. Buchbinder R, Green S, Youd JM, Johnston RV, Cumpston M (2008) Arthrographic distension for adhesive capsulitis (frozen shoulder). CD 23(1):007005

    Google Scholar 

  6. Chen R, Jiang C, Huang G (2019) Comparison of intra-articular and subacromial corticosteroid injection in frozen shoulder: A meta-analysis of randomized controlled trials. Int J Surg 68:92–103

    PubMed  Google Scholar 

  7. Codman EA (1934) The shoulder: rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Thomas Todd, Boston:216–224.

  8. Duchstein LDL, Jakobsen JR, Marker L, Okholm M, Friberg L et al (2020) The role of (18)F-FDG PET/CT in the diagnosis of frozen shoulder. Knee Surg Sports TraumatolArthrosc. https://doi.org/10.1007/s00167-020-05937-2

    Article  Google Scholar 

  9. Gallacher S, Beazley JC, Evans J, Anaspure R, Silver D et al (2018) A randomized controlled trial of arthroscopic capsular release versus hydrodilatation in the treatment of primary frozen shoulder. J Shoulder Elbow Surg 27(8):1401–1406

    PubMed  Google Scholar 

  10. Grant JA, Schroeder N, Miller BS, Carpenter JE (2013) Comparison of manipulation and arthroscopic capsular release for adhesive capsulitis: a systematic review. J Shoulder Elbow Surg 22(8):1135–1145

    PubMed  Google Scholar 

  11. Green S, Buchbinder R, Hetrick S (2003) Physiotherapy interventions for shoulder pain. CD 2:004258

    Google Scholar 

  12. Green S, Buchbinder R, Hetrick S (2005) Acupuncture for shoulder pain. CD 2:005319

    Google Scholar 

  13. Hagiwara Y, Kanazawa K, Ando A, Sekiguchi T, Koide M et al (2020) Effects of joint capsular release on range of motion in patients with frozen shoulder. J Shoulder Elbow Surg 29(9):1836–1842

    PubMed  Google Scholar 

  14. Harris JD, Brand JC, Cote MP, Faucett SC, Dhawan A (2017) Research Pearls: The Significance of Statistics and Perils of Pooling. Part 1: Clinical Versus Statistical Significance. Arthroscopy 33 (6):1102–1112.

  15. Ho CY, Sole G, Munn J (2009) The effectiveness of manual therapy in the management of musculoskeletal disorders of the shoulder: a systematic review. Man Ther 14(5):463–474

    PubMed  Google Scholar 

  16. Houck DA, Belk JW, Vidal AF, McCarty EC, Bravman JT et al (2019) Outcomes of arthroscopic capsular release in the beach-chair versus lateral decubitus position: a systematic review. Orthop J Sports Med 7(12):2325967119888173

    PubMed  PubMed Central  Google Scholar 

  17. Hunt H, Pollock A, Campbell P, Estcourt L, Brunton G (2018) An introduction to overviews of reviews: planning a relevant research question and objective for an overview. Syst Rev 7(1):39

    PubMed  PubMed Central  Google Scholar 

  18. Itoi E, Arce G, Bain GI, Diercks RL, Guttmann D et al (2016) Shoulder stiffness: current concepts and concerns. Arthroscopy 32(7):1402–1414

    PubMed  Google Scholar 

  19. Jacob C (1988) Statistical Power Analysis for the Behavioral Sciences. Lawrence Erlbaum Associates.

  20. Kitridis D, Tsikopoulos K, Bisbinas I, Papaioannidou P, Givissis P (2019) Efficacy of pharmacological therapies for adhesive capsulitis of the shoulder: a systematic review and network meta-analysis. Am J Sports Med 47(14):3552–3560

    PubMed  Google Scholar 

  21. Kwon CY, Yoon SH, Lee B (2019) Clinical effectiveness and safety of acupotomy: an overview of systematic reviews. Complement TherClinPract 36:142–152

    Google Scholar 

  22. Lee LC, Lieu FK, Lee HL, Tung TH (2015) Effectiveness of hyaluronic acid administration in treating adhesive capsulitis of the shoulder: a systematic review of randomized controlled trials. Biomed Res Int 2015:314120

    PubMed  PubMed Central  Google Scholar 

  23. Lin MT, Hsiao MY, Tu YK, Wang TG (2018) Comparative efficacy of intra-articular steroid injection and distension in patients with frozen shoulder: a systematic review and network meta-analysis. Arch Phys Med Rehabil 99(7):1383-1394.e1386

    PubMed  Google Scholar 

  24. Maund E, Craig D, Suekarran S, Neilson A, Wright K et al (2012) Management of frozen shoulder: a systematic review and cost-effectiveness analysis. Health Technol Assess 16(11):1–264

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Page MJ, Green S, Kramer S, Johnston RV, McBain B et al (2014) Electrotherapy modalities for adhesive capsulitis (frozen shoulder). CD 10:011324

    Google Scholar 

  26. Page MJ, Green S, Kramer S, Johnston RV, McBain B et al (2014) Manual therapy and exercise for adhesive capsulitis (frozen shoulder). CD 8:011275

    Google Scholar 

  27. Rangan A, Brealey SD, Keding A, Corbacho B, Northgraves M et al (2020) Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial. Lancet 396(10256):977–989

    CAS  PubMed  Google Scholar 

  28. Rookmoneea M, Dennis L, Brealey S, Rangan A, White B et al (2010) The effectiveness of interventions in the management of patients with primary frozen shoulder. J Bone Joint Surg Br 92(9):1267–1272

    CAS  PubMed  Google Scholar 

  29. Saito S, Furuya T, Kotake S (2010) Therapeutic effects of hyaluronate injections in patients with chronic painful shoulder: a meta-analysis of randomized controlled trials. Arthritis Care Res (Hoboken) 62(7):1009–1018

    CAS  Google Scholar 

  30. Saltychev M, Laimi K, Virolainen P, Fredericson M (2018) Effectiveness of hydrodilatation in adhesive capsulitis of shoulder: a systematic review and meta-analysis. Scand J Surg 107(4):285–293

    CAS  PubMed  Google Scholar 

  31. Sawilowsky S (2009) New effect size rules of thumb. JMASM 8:597–599

    Google Scholar 

  32. Shang X, Zhang Z, Pan X, Li J, Li Q (2019) Intra-articular versus subacromial corticosteroid injection for the treatment of adhesive capsulitis: a meta-analysis and systematic review. Biomed Res Int 2019:1274790

    PubMed  PubMed Central  Google Scholar 

  33. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C et al (2017) AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 358:j4008

    PubMed  PubMed Central  Google Scholar 

  34. Simovitch R, Flurin PH, Wright T, Zuckerman JD, Roche CP (2018) Quantifying success after total shoulder arthroplasty: the minimal clinically important difference. J Shoulder Elbow Surg 27(2):298–305

    PubMed  Google Scholar 

  35. Singh JA, Fitzgerald PM (2010) Botulinum toxin for shoulder pain. CD 9:008271

    Google Scholar 

  36. Smitherman JA, Struk AM, Cricchio M, McFadden G, Dell RB et al (2015) Arthroscopy and manipulation versus home therapy program in treatment of adhesive capsulitis of the shoulder: a prospective randomized study. J SurgOrthopAdv 24(1):69–74

    Google Scholar 

  37. Sun Y, Lu S, Zhang P, Wang Z, Chen J (2016) Steroid Injection versus physiotherapy for patients with adhesive capsulitis of the shoulder: a PRIMSA systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 95(20):e3469

    CAS  Google Scholar 

  38. Sun Y, Zhang P, Liu S, Li H, Jiang J et al (2017) Intra-articular steroid injection for frozen shoulder: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. Am J Sports Med 45(9):2171–2179

    PubMed  Google Scholar 

  39. Tashjian RZ, Deloach J, Porucznik CA, Powell AP (2009) Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. J Shoulder Elbow Surg 18(6):927–932

    PubMed  Google Scholar 

  40. Tashjian RZ, Hung M, Keener JD, Bowen RC, McAllister J et al (2017) Determining the minimal clinically important difference for the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and visual analog scale (VAS) measuring pain after shoulder arthroplasty. J Shoulder Elbow Surg 26(1):144–148

    PubMed  Google Scholar 

  41. Tedla JS, Sangadala DR (2019) Proprioceptive neuromuscular facilitation techniques in adhesive capsulitis: a systematic review and meta-analysis. J Musculoskelet Neuronal Interact 19(4):482–491

    PubMed  PubMed Central  Google Scholar 

  42. van der Heijden GJ, van der Windt DA, Kleijnen J, Koes BW, Bouter LM (1996) Steroid injections for shoulder disorders: a systematic review of randomized clinical trials. Br J Gen Pract 46(406):309–316

    PubMed  PubMed Central  Google Scholar 

  43. van der Windt DA, Koes BW, de Jong BA, Bouter LM (1995) Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis 54(12):959–964

    PubMed  PubMed Central  Google Scholar 

  44. Wang W, Shi M, Zhou C, Shi Z, Cai X et al (2017) Effectiveness of corticosteroid injections in adhesive capsulitis of shoulder: a meta-analysis. Medicine (Baltimore) 96(28):e7529

    CAS  Google Scholar 

  45. Wong CK, Levine WN, Deo K, Kesting RS, Mercer EA et al (2017) Natural history of frozen shoulder: fact or fiction? A systematic review Physiotherapy 103(1):40–47

    CAS  PubMed  Google Scholar 

  46. Wu WT, Chang KV, Han DS, Chang CH, Yang FS et al (2017) Effectiveness of glenohumeral joint dilatation for treatment of frozen shoulder: a systematic review and meta-analysis of randomized controlled trials. Sci Rep 7(1):10507

    PubMed  PubMed Central  Google Scholar 

  47. Yang R, Yang XD, Shu F, Zhang H (2018) Clinical effects of Kirschner wire with hole transverse fixation combined with titanium cable purse string suture for the treatment of refractory fracture of patellar comminuted fracture. ZhongguoGu Shang 31(10):894–898

    Google Scholar 

  48. Yoon JP, Chung SW, Lee BJ, Kim HS, Yi JH et al (2017) Correlations of magnetic resonance imaging findings with clinical symptom severity and prognosis of frozen shoulder. Knee Surg Sports TraumatolArthrosc 25(10):3242–3250

    Google Scholar 

  49. You J, Yang F, Liu N, Tang N, Fang T et al (2019) Acupotomy therapy for shoulder adhesive capsulitis: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med 2019:2010816

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors are grateful to Dr. Stefanie Malan-Muller for her assistance with literature review and data collection.

Funding

This study was funded by Fondation LaTour, Geneva, Switzerland.

Author information

Authors and Affiliations

Authors

Contributions

AL participated in conception, design, literature review, data collection and analysis, manuscript editing. SP participated in Conception, design, literature review, data collection and analysis, manuscript editing. SA participated in Conception, design, literature review, data collection and analysis, manuscript editing. AM participated in Conception, design, literature review, data collection and analysis, manuscript editing. MI participated in Conception, design, literature review, data collection and analysis, manuscript editing. PS participated in Conception, design, literature review, data collection and analysis, manuscript writing, figures and tables. All authors approved the final manuscript.

Corresponding author

Correspondence to Patrick Stirling.

Ethics declarations

Conflict of interest

Dr. Lädermann reports grants and personal fees from Wright, personal fees from Arthrex, personal fees from Medacta, outside the submitted work. AL, MI, PS, SA and SP declare no conflict of interest.

Ethical approval

Not required as this study is an overview of systematic reviews (registered on PROSPERO 167779).

Systematic review registration

PROSPERO (167779)

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file 1 (DOCX 19 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lädermann, A., Piotton, S., Abrassart, S. et al. Hydrodilatation with corticosteroids is the most effective conservative management for frozen shoulder. Knee Surg Sports Traumatol Arthrosc 29, 2553–2563 (2021). https://doi.org/10.1007/s00167-020-06390-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-06390-x

Keywords

Navigation