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Corticosteroid Injection Methods for Frozen Shoulder: A Network Meta-analysis.

Chun-Wei Liang1, Hsiao-Yi Cheng2, Yu-Hao Lee3

  • 1School of Medicine, College of Medicine, Taipei Medical University, Taipei; Department of Primary Care Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei.

Archives of Physical Medicine and Rehabilitation
|January 20, 2024
PubMed
Summary

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Corticosteroid injections for frozen shoulder, including rotator interval injection and distension, offer similar symptom relief. More research is needed to confirm if multiple injection sites provide superior benefits for frozen shoulder treatment.

Area of Science:

  • Orthopedics
  • Musculoskeletal Disorders
  • Pain Management

Background:

  • Frozen shoulder, or adhesive capsulitis, is a debilitating condition characterized by shoulder stiffness and pain.
  • Corticosteroid injections are a common treatment modality, but optimal injection techniques remain debated.

Purpose of the Study:

  • To compare the efficacy of different corticosteroid (CS) injection methods for treating frozen shoulder.
  • To identify the most effective CS injection techniques based on available evidence.

Main Methods:

  • A systematic review and network meta-analysis of randomized controlled trials (RCTs) were conducted.
  • Searches were performed in PubMed, Embase, and Cochrane Library up to May 6, 2023.
  • Data from 66 RCTs involving 4491 patients were analyzed using a frequentist network meta-analysis framework.
Keywords:
Adrenal cortex hormonesFrozen shoulderInjections

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Main Results:

  • For short-term pain and function, 4-site injection showed the most significant improvement (low certainty evidence).
  • Rotator interval injection demonstrated optimal effectiveness for both pain and function with moderate to high certainty.
  • Midterm outcomes also favored 4-site injection for pain and function (low certainty), while distension via rotator interval (D-RI) was optimal (moderate to high certainty).

Conclusions:

  • Rotator interval injection, distension, and intra-articular injection demonstrate comparable efficacy in relieving frozen shoulder symptoms.
  • Further high-quality RCTs are necessary to definitively establish the superiority of multisite injection strategies over single-site methods.