MA: intra-articular corticosteroids provide short-term relief in patients with adhesive capsulitis

Reference

Kitridis D, Tsikopoulos K, Bisbinas I, Papaioannidou P, Givissis P. Efficacy of pharmacological therapies for adhesive capsulitis of the shoulder: A systematic review and network meta-analysis. Am J Sports Med 2019;47(14):3552-3560.

Synopsis

These authors searched several databases and clinical trials registries to identify randomized trials of interventions to treat patients with adhesive capsulitis. The potential treatments included a whole boatload of stuff, including corticosteroids, sodium hyaluronate, platelet-rich plasma, nonsteroidal anti-inflammatory medications, collagenase Clostridium histolyticum, adalimumab, and saline; all delivered by mouth, by injection, or transdermally. Two authors independently assessed the studies for inclusion and for their methodologic quality. In addition to a traditional meta-analysis, the authors also performed a network meta-analysis to potentially identify the most effective interventions. Ultimately, they identified 30 studies with 2132 patients. One study was published in 1954, the remainder were published after 1991. Only 6 of the trials was at low risk of bias and 23 were of unclear risk. The mean age of the patients ranged from 50 years to 65.8 years and all patients had symptoms for at least 3 weeks. Although the authors tried to identify all relevant studies, they reported finding statistical evidence of publication bias. Ultimately, after performing a bunch of statistical gymnastics, the authors found that various approaches to intra-articular steroid injections provided short-term clinically important improvements in pain, but no long-term benefits.