Corticosteroid injections for shoulder pain - PubMed (original) (raw)

Review

Corticosteroid injections for shoulder pain

R Buchbinder et al. Cochrane Database Syst Rev. 2003.

Abstract

Background: While many treatments, including corticosteroid injections in and around the shoulder, are advocated to be of benefit for shoulder pain, few are of proven efficacy. This review of corticosteroid injections for shoulder pain is one in a series of reviews of varying interventions for shoulder disorders.

Objectives: To determine the efficacy and safety of corticosteroid injections in the treatment of adults with shoulder pain.

Search strategy: MEDLINE, EMBASE, CINAHL, Central and Science Citation Index were searched up to and including June 2002.

Selection criteria: Randomised and pseudo-randomised trials in all languages of corticosteroid injections compared to placebo or another intervention, or of varying types and dosages of steroid injection in adults with shoulder pain. Specific exclusions were duration of shoulder pain less than three weeks, rheumatoid arthritis, polymyalgia rheumatica and fracture.

Data collection and analysis: Trial inclusion and methodological quality was assessed by two independent reviewers according to predetermined criteria. Results are presented separately for rotator cuff disease, adhesive capsulitis, full thickness rotator cuff tear and mixed diagnoses, and, where possible, combined in meta-analysis.

Main results: Twenty-six trials met inclusion criteria. The number, site and dosage of injections varied widely between studies. The number of participants per trial ranged from 20 to 114 (median 52 participants). Methodological quality was variable. For rotator cuff disease, subacromial steroid injection was demonstrated to have a small benefit over placebo in some trials however no benefit of subacromial steroid injection over NSAID was demonstrated based upon the pooled results of three trials. For adhesive capsulitis, two trials suggested a possible early benefit of intra-articular steroid injection over placebo but there was insufficient data for pooling of any of the trials. One trial suggested short-term benefit of intra-articular corticosteroid injection over physiotherapy in the short-term (success at seven weeks RR=1.66 (1.21, 2.28).

Reviewer's conclusions: Despite many RCTs of corticosteroid injections for shoulder pain, their small sample sizes, variable methodological quality and heterogeneity means that there is little overall evidence to guide treatment. Subacromial corticosteroid injection for rotator cuff disease and intra-articular injection for adhesive capsulitis may be beneficial although their effect may be small and not well-maintained. There is a need for further trials investigating the efficacy of corticosteroid injections for shoulder pain. Other important issues that remain to be clarified include whether the accuracy of needle placement, anatomical site, frequency, dose and type of corticosteroid influences efficacy.

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Conflict of interest statement

None known.

Figures

1.1

1.1. Analysis

Comparison 1 INTRA‐ARTICULAR STEROID INJECTION VS PLACEBO, Outcome 1 Pain at 4 weeks.

1.2

1.2. Analysis

Comparison 1 INTRA‐ARTICULAR STEROID INJECTION VS PLACEBO, Outcome 2 Range of abduction at 4 weeks.

1.3

1.3. Analysis

Comparison 1 INTRA‐ARTICULAR STEROID INJECTION VS PLACEBO, Outcome 3 Success rate at 4 weeks.

2.1

2.1. Analysis

Comparison 2 SUBACROMIAL STEROID INJECTION VS PLACEBO, Outcome 1 Improvement in pain at 4 weeks.

2.2

2.2. Analysis

Comparison 2 SUBACROMIAL STEROID INJECTION VS PLACEBO, Outcome 2 Improvement in function at 4 weeks.

2.3

2.3. Analysis

Comparison 2 SUBACROMIAL STEROID INJECTION VS PLACEBO, Outcome 3 Improvement in range of active abduction at 4 weeks.

2.4

2.4. Analysis

Comparison 2 SUBACROMIAL STEROID INJECTION VS PLACEBO, Outcome 4 Remission at 4 weeks.

3.1

3.1. Analysis

Comparison 3 ANATOMICAL STEROID INJECTION (SITE DETERMINED BY CLINICAL FEATURES) VS TRIGGER POINT STEROID INJECTION, Outcome 1 Success rate at 1 week.

4.1

4.1. Analysis

Comparison 4 INTRA‐ARTICULAR STEROID INJECTION ‐ HIGHER DOSE (40 mg TRIAMCINOLONE ACTONIDE) VS LOWER DOSE (10 MG), Outcome 1 Improvement in pain at 6 weeks.

4.2

4.2. Analysis

Comparison 4 INTRA‐ARTICULAR STEROID INJECTION ‐ HIGHER DOSE (40 mg TRIAMCINOLONE ACTONIDE) VS LOWER DOSE (10 MG), Outcome 2 Improvement in disturbance of sleep at 6 weeks.

4.3

4.3. Analysis

Comparison 4 INTRA‐ARTICULAR STEROID INJECTION ‐ HIGHER DOSE (40 mg TRIAMCINOLONE ACTONIDE) VS LOWER DOSE (10 MG), Outcome 3 Improvement in functional impairment at 6 weeks.

4.4

4.4. Analysis

Comparison 4 INTRA‐ARTICULAR STEROID INJECTION ‐ HIGHER DOSE (40 mg TRIAMCINOLONE ACTONIDE) VS LOWER DOSE (10 MG), Outcome 4 Improvement in external rotation at 6 weeks.

4.5

4.5. Analysis

Comparison 4 INTRA‐ARTICULAR STEROID INJECTION ‐ HIGHER DOSE (40 mg TRIAMCINOLONE ACTONIDE) VS LOWER DOSE (10 MG), Outcome 5 Frequency of adverse effects.

5.1

5.1. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 1 Treatment success at 7 weeks.

5.2

5.2. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 2 Improvement in severity of main complaint at 3 weeks.

5.3

5.3. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 3 Improvement in pain during day at 3 weeks.

5.4

5.4. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 4 Improvement in pain at night at 3 weeks.

5.5

5.5. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 5 Improvement in pain as rated by an observer at 3 weeks.

5.6

5.6. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 6 Improvement in functional disability at 3 weeks.

5.7

5.7. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 7 improvement in abduction at 3 weeks.

5.8

5.8. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 8 Improvement in severity of main complaint at 7 weeks.

5.9

5.9. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 9 Improvement in pain during day at 7 weeks.

5.10

5.10. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 10 Improvement in pain at night at 7 weeks.

5.11

5.11. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 11 Improvement in pain as rated by observer at 7 weeks.

5.12

5.12. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 12 Improvement in functional disability at 7 weeks.

5.13

5.13. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 13 Improvement in abduction at 7 weeks.

5.14

5.14. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 14 improvement in severity of main complaint at 13 weeks.

5.15

5.15. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 15 Improvement in pain during day at 13 weeks.

5.16

5.16. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 16 Improvement in pain at night at 13 weeks.

5.17

5.17. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 17 Improvement in shoulder disability at 13 weeks.

5.18

5.18. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 18 Improvement in severity of main complaint at 26 weeks.

5.19

5.19. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 19 Improvement in pain during day at 26 weeks.

5.20

5.20. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 20 Improvement in pain during night at 26 weeks.

5.21

5.21. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 21 Improvement in pain as rated by observer at 26 weeks.

5.22

5.22. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 22 Improvement in functional disability at 26 weeks.

5.23

5.23. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 23 Improvement in abduction at 26 weeks.

5.24

5.24. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 24 Improvement in severity of main complaint at 52 weeks.

5.25

5.25. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 25 Improvement in pain during day at 52 weeks.

5.26

5.26. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 26 Improvement in pain at night at 52 weeks.

5.27

5.27. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 27 Improvement in shoulder disabiltiy at 52 weeks.

5.28

5.28. Analysis

Comparison 5 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY, Outcome 28 Frequency of adverse effects.

6.1

6.1. Analysis

Comparison 6 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY AND NSAID, Outcome 1 Pain at 2 weeks.

6.2

6.2. Analysis

Comparison 6 INTRA‐ARTICULAR STEROID INJECTION VS PHYSIOTHERAPY AND NSAID, Outcome 2 Pain at 12 weeks.

7.1

7.1. Analysis

Comparison 7 INTRA‐ARTICULAR STEROID INJECTION VS CAPSULAR DISTENSION WITH AIR, Outcome 1 Improvement in abduction at 16 weeks.

8.1

8.1. Analysis

Comparison 8 INTRA‐ARTICULAR STEROID INJECTIONS VS ULTRASOUND, Outcome 1 Pain at 4 weeks.

8.2

8.2. Analysis

Comparison 8 INTRA‐ARTICULAR STEROID INJECTIONS VS ULTRASOUND, Outcome 2 Range of abduction at 4 weeks.

8.3

8.3. Analysis

Comparison 8 INTRA‐ARTICULAR STEROID INJECTIONS VS ULTRASOUND, Outcome 3 Success rate at 4 weeks.

9.1

9.1. Analysis

Comparison 9 INTRA‐ARTICULAR STEROID INJECTION VS ACUPUNCTURE, Outcome 1 Pain at 4 weeks.

9.2

9.2. Analysis

Comparison 9 INTRA‐ARTICULAR STEROID INJECTION VS ACUPUNCTURE, Outcome 2 Range of abduction at 4 weeks.

9.3

9.3. Analysis

Comparison 9 INTRA‐ARTICULAR STEROID INJECTION VS ACUPUNCTURE, Outcome 3 Success rate at 4 weeks.

10.1

10.1. Analysis

Comparison 10 INTRA‐ARTICULAR STEROID INJECTION VS HYALURONATE INJECTION, Outcome 1 Satisfaction with treatment at 4 weeks.

11.1

11.1. Analysis

Comparison 11 SUBACROMIAL STEROID INJECTION VS NSAID, Outcome 1 Improvement in pain at 4 or 6 weeks.

11.2

11.2. Analysis

Comparison 11 SUBACROMIAL STEROID INJECTION VS NSAID, Outcome 2 Improvement in function at 4 or 6 weeks.

11.3

11.3. Analysis

Comparison 11 SUBACROMIAL STEROID INJECTION VS NSAID, Outcome 3 Improvement in range of shoulder abduction at 4 or 6 weeks.

11.4

11.4. Analysis

Comparison 11 SUBACROMIAL STEROID INJECTION VS NSAID, Outcome 4 Improvement in global assessment score at 6 weeks.

12.1

12.1. Analysis

Comparison 12 INTRA‐ARTICULAR, SUBACROMIAL AND ACROMIOCLAVICULAR STEROID INJECTIONS VS PHYSIOTHERAPY (NOT MANIPULATION), Outcome 1 Pain at end of treatment (when patient left study or 11 weeks after randomisation).

13.1

13.1. Analysis

Comparison 13 INTRA‐ARTICULAR, SUBACROMIAL and ACROMIOCLAVICULAR STEROID INJECTIONS VS MANIPULATION, Outcome 1 Pain at end of treatment (when patient left study or 11 weeks after randomisation).

14.1

14.1. Analysis

Comparison 14 INTRA‐ARTICULAR STEROID INJECTION PLUS NSAID VS PLACEBO, Outcome 1 Pain at 4 weeks.

14.2

14.2. Analysis

Comparison 14 INTRA‐ARTICULAR STEROID INJECTION PLUS NSAID VS PLACEBO, Outcome 2 Range of abduction at 4 weeks.

14.3

14.3. Analysis

Comparison 14 INTRA‐ARTICULAR STEROID INJECTION PLUS NSAID VS PLACEBO, Outcome 3 Success rate at 4 weeks.

15.1

15.1. Analysis

Comparison 15 INTRA‐ARTICULAR STEROID INJECTION PLUS MANIPULATION UNDER ANAESTHESIA VS MANIPULATION UNDER ANAESTHESIA ALONE, Outcome 1 Range of abduction at 4 months.

16.1

16.1. Analysis

Comparison 16 SUBACROMIAL STEROID INJECTION PLUS NSAID VS NSAID ALONE, Outcome 1 Improvement in pain at 4 weeks.

16.2

16.2. Analysis

Comparison 16 SUBACROMIAL STEROID INJECTION PLUS NSAID VS NSAID ALONE, Outcome 2 Improvement in function at 4 weeks.

16.3

16.3. Analysis

Comparison 16 SUBACROMIAL STEROID INJECTION PLUS NSAID VS NSAID ALONE, Outcome 3 Improvement in range of abduction at 4 weeks.

16.4

16.4. Analysis

Comparison 16 SUBACROMIAL STEROID INJECTION PLUS NSAID VS NSAID ALONE, Outcome 4 Remission at 4 weeks.

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References

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