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Got It, Hide thisSun Y, Zhang P, Liu S, et al. 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. 2017;45:2171-9.
In people with frozen shoulder (adhesive capsulitis), do steroid injections into the joint reduce pain or improve functioning?
Frozen shoulder is common and is caused by thickening of the connective tissue around the shoulder joint. It causes pain and stiffness in the joint and limits shoulder movement. It develops slowly and has 3 stages. In the initial freezing stage, moving your shoulder will be painful and you won’t be able to move it as far as before. In the frozen stage, you may have less pain but more stiffness and difficulty moving your shoulder. In the final thawing stage, your shoulder movement improves. Frozen shoulder generally resolves within 3 years.
Treatment for frozen shoulder includes steroid injections into the shoulder joint, drugs to relieve pain or reduce inflammation, physical therapy including range-of-motion exercises, and shoulder manipulation. Surgery is rarely done for frozen shoulder. This review assessed how well steroid injections work.
The researchers did a systematic review of studies available up to December 2015. They found 8 randomized controlled trials with 416 people.
The key features of the studies were:
Compared with placebo or no injections, steroid injections:
There wasn’t much information reported about the adverse effects of steroid injections.
In people with frozen shoulder, steroid injections into the shoulder joint reduce pain and improve mobility for up to 6 months.
Outcomes | Follow-up period | Number of trials | Absolute effects of steroid injections |
Pain | 4 to 6 weeks | 5 trials | Reduced pain scores by 1.3 points out of 10. |
| 12 to 16 weeks | 5 trials | Reduced pain scores by 1 point out of 10. |
| 24 to 26 weeks | 4 trials | Reduced pain scores by 0.6 points out of 10. |
Shoulder mobility | 4 to 6 weeks | 3 trials | Improved range of shoulder movement† by 8 to 14 degrees. |
| 12 to 16 weeks | 4 to 5 trials | Improved range of shoulder movement† by 6 to 18 degrees. |
| 24 to 26 weeks | 2 trials | Improved range of shoulder movement† by 7 to 10 degrees. |
Shoulder Pain and Disability Index score | 4 to 6 weeks | 3 trials | Improved the Index score by 17 points out of 100. |
| 12 to 16 weeks | 4 trials | Improved the Index score by 13 points out of 100. |
| 24 to 26 weeks | 2 trials | Improved the Index score by 10 points out of 100. |