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

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

Authors
Alexandre Lädermann Sébastien Piotton Sophie Abrassart, Adrien Mazzolari, Mohamed Ibrahim, Patrick Stirling

Reference
Knee Surg Sports Traumatol Arthrosc. 2020 Aug;28(8):2390-2402.

Background
Numerous studies have investigated the conservative treatment options for frozen shoulder. No consensus has been reached on how to best manage patients with this condition.

Methodology
An overview of metanalyses that compare conservative treatment options for frozen shoulder.

Two reviewers assessed the quality of included meta-analyses using AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews) and conducted a narrative synthesis of the studies’ outcomes.

Inclusion criteria
– Meta-analysis listed in PubMed, Web of Science or the Cochrane Library
– Included ≥ 3 randomised controlled trials (RCT)
– Evaluated patients with frozen shoulder/ adhesive capsulitis;
– Reported ≥ 1 management pathways or approaches
– Results included ≥ 2 of: pain on a visual-analogue scale, shoulder function score or range of motion (ROM).

Exclusion Criteria
– Non English transcript
– Reported exclusively on shoulder stiffness with a known aetiology or comorbidities;
– Reported on a range of pathologies

Conclusion/s
319 studies were initially identified, and 8 meta-analyses were included in final evaluation. Of these 3 were evaluated as low quality and 5 as critically low-quality.

Following narrative synthesis, the authors determined:

Intra-articular corticosteroid injection and arthrographic distension/hydrodilatation with corticosteroid provides advantages over placebo in short-term pain relief, 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.

Other comments
Strengths
Protocol set out a priori and registered PROSPERO (167779)
Included meta-analysis contained at ≥ 3 RCTs

Limitations:
Included studies had heterogeneity in data including methods of reporting and duration of follow up. This impacted the authors ability to draw conclusions and prevented a metanalysis being undertaken.
Some treatment modalities were not considered in the review due to insufficient RCT being conducted.

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