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

Abstract

Purpose The purpose of this overview is to summarise the indings 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 identiied, 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 suicient 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

The Efficacy of Manipulation with Distension Arthrography to Treat Adhesive Capsulitis: A Multicenter, Randomized, Single-Blind, Controlled Trial

“…Although there is reportedly no significant difference in the efficacy of distension arthrography versus intra-articular injection in the treatment of shoulder periarthritis [ 28 ], distension arthrography achieves a reliable therapeutic effect and significantly improves the function and ROM of the shoulder in the long-term [ 29 ]. Further study is needed to determine whether distension arthrography achieves clinically better improvements than intra-articular injection alone.…”

Behandlung bei Erwachsenen mit primärer Frozen Shoulder in der Sekundärversorgung (UK FROST): eine multizentrische, pragmatische, dreiarmige, randomisierte klinische Überlegenheitsstudie

“…Demzufolge ist die Klassifizierung gelesen und kommentiert der verschiedenen Stadien einer FS sowie optimale Behandlungsempfehlungen für Physiotherapeut*innen in der Klinik wichtig. Obwohl bereits mehrere Jahrzehnte über FS geforscht wird, scheint es keine alleinige konservative oder operative Behandlungsmethode zu geben, die generell favorisiert werden kann [1].…”

“…Dennoch ist dieses Zwischenergebnis mit Vorsicht zu bewerten, da die Teilnehmenden der Studie unterschiedlich lange auf den Behandlungsstart warten mussten, was das Ergebnis beeinflusst haben könnte. Zudem zeigen Kortikosteroidinjektionen ebenfalls kurzfristige Behandlungserfolge [1]. Aus der Studie von Rangan et al [2] geht außerdem hervor, dass alle 3 untersuchten Methoden, Manipulation unter Narkose, arthroskopisches Lösen der Kapselverklebung und frühzeitige strukturierte Physiotherapie, mit intraartikulärer Steroidinjektion nach 12 Monaten vergleichbare Resultate erzielen.…”

The role of suprascapular nerve block in hydrodilatation for frozen shoulder

“…The procedure may be given with or without an adjuvant corticosteroid. Hydrodilatation, using saline and a corticosteroid, was superior in short-term pain reduction and range of motion improvement compared to management using only physiotherapy and corticosteroid injection in patients treated for frozen shoulder [5]. The proposed hypothesis regarding the mechanism of action in hydrodilatation and pain reduction in patients with the frozen shoulder was associated with synovitis and fibrosis removal [6,7].…”