Comparison of Treatments for Frozen Shoulder : A Systematic Review and Meta-analysis

ABSTRACT: Key Points

Question

Are any treatment modalities for frozen shoulder associated with better outcomes than other treatments?

Findings

In this meta-analysis of 65 studies with 4097 participants, intra-articular corticosteroid was associated with increased short-term benefits compared with other nonsurgical treatments, and its superiority appeared to last for as long as 6 months. The addition of a home exercise program and/or electrotherapy or passive mobilizations may be associated with added benefits.

Meaning

The results of this study suggest that intra-articular corticosteroid should be offered to patients with frozen shoulder at first contact. This systematic review and meta-analysis assesses and compares the effectiveness of available treatment options for frozen shoulder to guide musculoskeletal practitioners and inform guidelines.

Importance

There are a myriad of available treatment options for patients with frozen shoulder, which can be overwhelming to the treating health care professional.

Objective

To assess and compare the effectiveness of available treatment options for frozen shoulder to guide musculoskeletal practitioners and inform guidelines.

Data Sources

Medline, EMBASE, Scopus, and CINHAL were searched in February 2020.

Study Selection

Studies with a randomized design of any type that compared treatment modalities for frozen shoulder with other modalities, placebo, or no treatment were included.

Data Extraction and Synthesis

Data were independently extracted by 2 individuals. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Random-effects models were used.

Main Outcomes and Measures

Pain and function were the primary outcomes, and external rotation range of movement (ER ROM) was the secondary outcome. Results of pairwise meta-analyses were presented as mean differences (MDs) for pain and ER ROM and standardized mean differences (SMDs) for function. Length of follow-up was divided into short-term (?12 weeks), mid-term (>12 weeks to ?12 months), and long-term (>12 months) follow-up.

Results

From a total of 65 eligible studies with 4097 participants that were included in the systematic review, 34 studies with 2402 participants were included in pairwise meta-analyses and 39 studies with 2736 participants in network meta-analyses. Despite several statistically significant results in pairwise meta-analyses, only the administration of intra-articular (IA) corticosteroid was associated with statistical and clinical superiority compared with other interventions in the short-term for pain (vs no treatment or placebo: MD, ?1.0 visual analog scale [VAS] point; 95% CI, ?1.5 to ?0.5 VAS points; P?Conclusions and Relevance The findings of this study suggest that the early use of IA corticosteroid in patients with frozen shoulder of less than 1-year duration is associated with better outcomes. This treatment should be accompanied by a home exercise program to maximize the chance of recovery.

SUBMITTER: Challoumas D 

PROVIDER: S-EPMC7745103 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature