What is the evidence for corticosteroid injections in treating adhesive capsulitis?
AMSTAR Rating
Summary
Patient Population:
Mean symptom duration ranged from 1342 – 2135 wks (25-40 years). Mean age of ranged from 54 – 57 years and the proportion of women ranged from 42% – 63%.
Intervention:
Two steroids were injected: methylprednisolone acetate (40 mg) and triamcinolone hexacetonide (20 or 40 mg). Participants were grouped into categories of 3 or fewer injections or more than 3 injections. A single injection was the most common.
Comparison:
Corticosteroid injection was compared to a placebo injection. Combined therapy of a corticosteroid injection with physiotherapy was compared to a placebo condition.
Outcome:
- Pain: corticosteroid injection vs. placebo injection – significant difference in favour of injection (pooled SMD = -1.15; 95% CI -1.62, -0.67; 2 studies, n=40).
- Function: corticosteroid injection vs. placebo injection – non-significant benefit in favour of injection (pooled MD = -1.05, 95% CI=-9.68, 7.58).
- ROM: corticosteroid injection vs. placebo injection – significant difference in favour of injection at 6 weeks (pooled MD = 3.22, 95% CI -3.29, 9.7) and 6 months (pooled MD=4.62, 95% CI -2.76, 1.9).
- Combined Therapy: Three studies (n=67) offered comparisons of combined therapy (corticosteroid injection & physiotherapy) vs. a placebo injection. A significant benefit was found in favour of combined therapy in all three outcome measures at 6 weeks and 3 months post-injection.
Guideline Recommendations
| Source | Recommendation |
|---|---|
| ACOEM, 2011 | Level A |
| APTA, 2013 | Level A |
| CSP, 2011 | Probably Use |
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Corticosteroid Injection vs. Placebo
Pain
Function
ROM
Corticosteroid Injection + Physiotherapy vs. Placebo
Pain
Function
ROM
Relevant Clinical Info
This is Temporary Data that is needed for the display and layout testing. The NNT to achieve an improvement in pain ranged from 4 to 16. No significant difference was found overall between the safety of acetaminophen and NSAIDs, although patients taking traditional NSAIDS were more likely to experience an adverse GI event (RR 1.47, (95% CI 1.08 to 2.00). 19% of patients in the traditional NSAID group versus 13% in the acetaminophen group experienced an adverse GI event.
