Physiotherapy interventions for shoulder pain - PubMed (original) (raw)

Review

Physiotherapy interventions for shoulder pain

S Green et al. Cochrane Database Syst Rev. 2003.

Abstract

Background: The prevalence of shoulder disorders has been reported to range from seven to 36% of the population (Lundberg 1969) accounting for 1.2% of all General Practitioner encounters in Australia (Bridges Webb 1992). Substantial disability and significant morbidity can result from shoulder disorders. While many treatments have been employed in the treatment of shoulder disorders, few have been proven in randomised controlled trials. Physiotherapy is often the first line of management for shoulder pain and to date its efficacy has not been established. This review is one in a series of reviews of varying interventions for shoulder disorders, updated from an earlier Cochrane review of all interventions for shoulder disorder.

Objectives: To determine the efficacy of physiotherapy interventions for disorders resulting in pain, stiffness and/or disability of the shoulder.

Search strategy: MEDLINE, EMBASE, the Cochrane Clinical Trials Regiter and CINAHL were searched 1966 to June 2002. The Cochrane Musculoskeletal Review Group's search strategy was used and key words gained from previous reviews and all relevant articles were used as text terms in the search.

Selection criteria: Each identified study was assessed for possible inclusion by two independent reviewers. The determinants for inclusion were that the trial be of an intervention generally delivered by a physiotherapist, that treatment allocation was randomised; and that the study population be suffering from a shoulder disorder, excluding trauma and systemic inflammatory diseases such as rheumatoid arthritis.

Data collection and analysis: The methodological quality of the included trials was assessed by two independent reviewers according to a list of predetermined criteria, which were based on the PEDro scale specifically designed for the assessment of validity of trials of physiotherapy interventions. Outcome data was extracted and entered into Revman 4.1. Means and standard deviations for continuous outcomes and number of events for binary outcomes were extracted where available from the published reports. All standard errors of the mean were converted to standard deviation. For trials where the required data was not reported or not able to be calculated, further details were requested from first authors. If no further details were provided, the trial was included in the review and fully described, but not included in the meta-analysis. Results were presented for each diagnostic sub group (rotator cuff disease, adhesive capsulitis, anterior instability etc) and, where possible, combined in meta-analysis to give a treatment effect across all trials.

Main results: Twenty six trials met inclusion criteria. Methodological quality was variable and trial populations were generally small (median sample size = 48, range 14 to 180). Exercise was demonstrated to be effective in terms of short term recovery in rotator cuff disease (RR 7.74 (1.97, 30.32), and longer term benefit with respect to function (RR 2.45 (1.24, 4.86). Combining mobilisation with exercise resulted in additional benefit when compared to exercise alone for rotator cuff disease. Laser therapy was demonstrated to be more effective than placebo (RR 3.71 (1.89, 7.28) for adhesive capsulitis but not for rotator cuff tendinitis. Both ultrasound and pulsed electromagnetic field therapy resulted in improvement compared to placebo in pain in calcific tendinitis (RR 1.81 (1.26, 2.60) and RR 19 (1.16, 12.43) respectively). There is no evidence of the effect of ultrasound in shoulder pain (mixed diagnosis), adhesive capsulitis or rotator cuff tendinitis. When compared to exercises, ultrasound is of no additional benefit over and above exercise alone. There is some evidence that for rotator cuff disease, corticosteroid injections are superior to physiotherapy and no evidence that physiotherapy alone is of benefit for Adhesive Capsulitis

Reviewer's conclusions: The small sample sizes, variable methodological quality and heterogeneity in terms of population studied, physiotherapy intervention employed and length of follow up of randomised controlled trials of physiotherapy interventions results in little overall evidence to guide treatment. There is evidence to support the use of some interventions in specific and circumscribed cases. There is a need for trials of physiotherapy interventions for specific clinical conditions associated with shoulder pain, for shoulder pain where combinations of physiotherapy interventions, as well as, physiotherapy interventions as an adjunct to other, non physiotherapy interventions are compared. This is more reflective of current clinical practice. Trials should be adequately powered and address key methodological criteria such as allocation concealment and blinding of outcome assessor.

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Figures

1.1

1.1. Analysis

Comparison 1 BIPOLAR INTERFERENTIAL CURRENT VERSUS PLACEBO, Outcome 1 Recovery or substantial improvement at 6 weeks.

1.2

1.2. Analysis

Comparison 1 BIPOLAR INTERFERENTIAL CURRENT VERSUS PLACEBO, Outcome 2 Recovery or substantial improvement (participant rated) at 3 months.

1.3

1.3. Analysis

Comparison 1 BIPOLAR INTERFERENTIAL CURRENT VERSUS PLACEBO, Outcome 3 Recovery or substantial improvement (participant rated) at 6 months.

1.4

1.4. Analysis

Comparison 1 BIPOLAR INTERFERENTIAL CURRENT VERSUS PLACEBO, Outcome 4 Recovery or substantial improvement (participant rated) at 9 months.

1.5

1.5. Analysis

Comparison 1 BIPOLAR INTERFERENTIAL CURRENT VERSUS PLACEBO, Outcome 5 Recovery or substantial improvement (participant rated) at 12 months.

2.1

2.1. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 1 Recovery or substantial improvement (participant rated) ‐ short term.

2.2

2.2. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 2 Recovery or substantial improvement (participant rated) at 3 months.

2.3

2.3. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 3 Recovery or substantial improvement (participant rated) at 6 months.

2.4

2.4. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 4 Recovery or substantial improvement (participant rated) at 9 months.

2.5

2.5. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 5 Recovery or substantial improvement (participant rated) at 12 months.

2.6

2.6. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 6 Resolution or improvement of radiological finding at end of treatment (6 weeks).

2.7

2.7. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 7 Resolution or improvement of radiological finding at 9 months.

2.8

2.8. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 8 Normal function at end of treatment (6 weeks).

2.9

2.9. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 9 Normal function at 9 months.

2.10

2.10. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 10 Change in range of flexion.

2.11

2.11. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 11 Range of abduction.

2.12

2.12. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 12 Change in internal rotation.

2.13

2.13. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 13 Change in external rotation.

2.14

2.14. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 14 Pain (100mmVAS) at 4 weeks.

2.15

2.15. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 15 Painfree at 4 weeks.

2.16

2.16. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 16 Pain (out of 20) at 4 months.

2.17

2.17. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 17 Pain (out of 20) at 12 months.

2.18

2.18. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 18 Function (out of 14) at 4 months.

2.19

2.19. Analysis

Comparison 2 ULTRASOUND VERSUS PLACEBO, Outcome 19 Function (out of 14) at 12 months.

3.1

3.1. Analysis

Comparison 3 SUPERVISED EXERCISES VERSUS PLACEBO OR NO TREATMENT, Outcome 1 Good or excellent function (Neer score) at 2 and a half years.

3.2

3.2. Analysis

Comparison 3 SUPERVISED EXERCISES VERSUS PLACEBO OR NO TREATMENT, Outcome 2 No pain on activity at 2 and a half years.

3.3

3.3. Analysis

Comparison 3 SUPERVISED EXERCISES VERSUS PLACEBO OR NO TREATMENT, Outcome 3 No pain at rest at 2 and a half years.

3.4

3.4. Analysis

Comparison 3 SUPERVISED EXERCISES VERSUS PLACEBO OR NO TREATMENT, Outcome 4 No pain at night at two and a half years.

3.5

3.5. Analysis

Comparison 3 SUPERVISED EXERCISES VERSUS PLACEBO OR NO TREATMENT, Outcome 5 Substantial improvement or recovered post treatment (1 month). Participant rated.

3.6

3.6. Analysis

Comparison 3 SUPERVISED EXERCISES VERSUS PLACEBO OR NO TREATMENT, Outcome 6 No pain post treatment (1 month).

3.7

3.7. Analysis

Comparison 3 SUPERVISED EXERCISES VERSUS PLACEBO OR NO TREATMENT, Outcome 7 Good or excellent function post treatment (1 month).

3.8

3.8. Analysis

Comparison 3 SUPERVISED EXERCISES VERSUS PLACEBO OR NO TREATMENT, Outcome 8 Worsened range of abduction post treatment (1 month).

4.1

4.1. Analysis

Comparison 4 LASER VERSUS PLACEBO, Outcome 1 Excellent or good result.

4.2

4.2. Analysis

Comparison 4 LASER VERSUS PLACEBO, Outcome 2 Change in Range of Movement at four weeks.

4.3

4.3. Analysis

Comparison 4 LASER VERSUS PLACEBO, Outcome 3 Change in night pain at four weeks.

4.4

4.4. Analysis

Comparison 4 LASER VERSUS PLACEBO, Outcome 4 Change in pain at rest at four weeks.

4.5

4.5. Analysis

Comparison 4 LASER VERSUS PLACEBO, Outcome 5 Change in pain on movement at four weeks.

4.6

4.6. Analysis

Comparison 4 LASER VERSUS PLACEBO, Outcome 6 Change in function at four weeks.

4.7

4.7. Analysis

Comparison 4 LASER VERSUS PLACEBO, Outcome 7 Change in range of movement at 8 weeks.

4.8

4.8. Analysis

Comparison 4 LASER VERSUS PLACEBO, Outcome 8 Change in night pain at 8 weeks.

4.9

4.9. Analysis

Comparison 4 LASER VERSUS PLACEBO, Outcome 9 Change in pain at rest at 8 weeks.

4.10

4.10. Analysis

Comparison 4 LASER VERSUS PLACEBO, Outcome 10 Change in pain on movement at 8 weeks.

4.11

4.11. Analysis

Comparison 4 LASER VERSUS PLACEBO, Outcome 11 Change in function at 8 weeks.

5.1

5.1. Analysis

Comparison 5 PULSED ELECTROMAGNETIC FIELD VERSUS PLACEBO, Outcome 1 No pain at end of treatment (6 days).

5.2

5.2. Analysis

Comparison 5 PULSED ELECTROMAGNETIC FIELD VERSUS PLACEBO, Outcome 2 No pain at 4‐6 Weeks.

5.3

5.3. Analysis

Comparison 5 PULSED ELECTROMAGNETIC FIELD VERSUS PLACEBO, Outcome 3 Adverse effects.

6.1

6.1. Analysis

Comparison 6 IONTOPHORESIS WITH ACETIC ACID PLUS ULTRASOUND VERSUS NO TREATMENT, Outcome 1 Percent change in size of calcium deposit.

6.2

6.2. Analysis

Comparison 6 IONTOPHORESIS WITH ACETIC ACID PLUS ULTRASOUND VERSUS NO TREATMENT, Outcome 2 Percent improvement in abduction.

7.1

7.1. Analysis

Comparison 7 BIPOLAR INTERFERENTIAL CURRENT VERSUS ULTRASOUND, Outcome 1 Recovery or substantial improvement (participant rated) at 6 weeks.

7.2

7.2. Analysis

Comparison 7 BIPOLAR INTERFERENTIAL CURRENT VERSUS ULTRASOUND, Outcome 2 Recovery or substantial improvement (participant rated) at 3 months.

7.3

7.3. Analysis

Comparison 7 BIPOLAR INTERFERENTIAL CURRENT VERSUS ULTRASOUND, Outcome 3 Recovery or substantial improvement (participant rated) at 6 months.

7.4

7.4. Analysis

Comparison 7 BIPOLAR INTERFERENTIAL CURRENT VERSUS ULTRASOUND, Outcome 4 Recovery or substantial improvement (participant rated) at 9 months.

7.5

7.5. Analysis

Comparison 7 BIPOLAR INTERFERENTIAL CURRENT VERSUS ULTRASOUND, Outcome 5 Recovery or substantial improvement (participant rated) at 12 months.

8.1

8.1. Analysis

Comparison 8 TENS VERSUS ULTRASOUND, Outcome 1 Pain on VAS.

9.1

9.1. Analysis

Comparison 9 MOBILISATION PLUS EXERCISE VERSUS EXERCISE ALONE, Outcome 1 Range of internal rotation at 3 to 4 weeks.

9.2

9.2. Analysis

Comparison 9 MOBILISATION PLUS EXERCISE VERSUS EXERCISE ALONE, Outcome 2 Range of abduction at 3 to 4 weeks.

9.3

9.3. Analysis

Comparison 9 MOBILISATION PLUS EXERCISE VERSUS EXERCISE ALONE, Outcome 3 Pain at 3 to 4 weeks.

9.4

9.4. Analysis

Comparison 9 MOBILISATION PLUS EXERCISE VERSUS EXERCISE ALONE, Outcome 4 Range of passive abduction at 4 weeks.

9.5

9.5. Analysis

Comparison 9 MOBILISATION PLUS EXERCISE VERSUS EXERCISE ALONE, Outcome 5 Composite strength score at 3 weeks.

9.6

9.6. Analysis

Comparison 9 MOBILISATION PLUS EXERCISE VERSUS EXERCISE ALONE, Outcome 6 Function at 3 weeks.

9.7

9.7. Analysis

Comparison 9 MOBILISATION PLUS EXERCISE VERSUS EXERCISE ALONE, Outcome 7 Pain on subacromial compression (mm on VAS) at 3 weeks.

9.8

9.8. Analysis

Comparison 9 MOBILISATION PLUS EXERCISE VERSUS EXERCISE ALONE, Outcome 8 Range of elevation (degrees) at 3 weeks.

9.9

9.9. Analysis

Comparison 9 MOBILISATION PLUS EXERCISE VERSUS EXERCISE ALONE, Outcome 9 Range of external rotation (degrees) at 3 weeks.

10.1

10.1. Analysis

Comparison 10 MOBLISATION/ MANIPULATION VERSUS EXERCISES AND ELECTROTHERAPY, Outcome 1 Pain at end of intervention period.

10.2

10.2. Analysis

Comparison 10 MOBLISATION/ MANIPULATION VERSUS EXERCISES AND ELECTROTHERAPY, Outcome 2 "Cured" at 5 weeks (participant rated).

10.3

10.3. Analysis

Comparison 10 MOBLISATION/ MANIPULATION VERSUS EXERCISES AND ELECTROTHERAPY, Outcome 3 "Not cured" (participant rated) at 2 and a half years (in those followed up).

11.1

11.1. Analysis

Comparison 11 ISOKINETIC RESISTANCE EXERCISES VERSUS ELECTROMYOGRAPHIC BIOFEEDBACK, Outcome 1 No functional limitation at work at 8 weeks.

11.2

11.2. Analysis

Comparison 11 ISOKINETIC RESISTANCE EXERCISES VERSUS ELECTROMYOGRAPHIC BIOFEEDBACK, Outcome 2 No functional limitation at work at 26 weeks.

11.3

11.3. Analysis

Comparison 11 ISOKINETIC RESISTANCE EXERCISES VERSUS ELECTROMYOGRAPHIC BIOFEEDBACK, Outcome 3 No functional limitation at work at 1 year.

11.4

11.4. Analysis

Comparison 11 ISOKINETIC RESISTANCE EXERCISES VERSUS ELECTROMYOGRAPHIC BIOFEEDBACK, Outcome 4 No functional limitation at in sport at 8 weeks.

11.5

11.5. Analysis

Comparison 11 ISOKINETIC RESISTANCE EXERCISES VERSUS ELECTROMYOGRAPHIC BIOFEEDBACK, Outcome 5 No functional limitation in sport at 26 weeks.

11.6

11.6. Analysis

Comparison 11 ISOKINETIC RESISTANCE EXERCISES VERSUS ELECTROMYOGRAPHIC BIOFEEDBACK, Outcome 6 No functional limitation in sport at 1 year.

12.1

12.1. Analysis

Comparison 12 PHYSIOTHERAPY WITH ELECTRO MAGNETIC THERAPY VERSUS PHYSIOTHERAPY WITH NO ELECTRO MAGNETIC THERAPY, Outcome 1 Range of shoulder flexion at 12 weeks.

12.2

12.2. Analysis

Comparison 12 PHYSIOTHERAPY WITH ELECTRO MAGNETIC THERAPY VERSUS PHYSIOTHERAPY WITH NO ELECTRO MAGNETIC THERAPY, Outcome 2 Range of shoulder abduction at 12 weeks.

12.3

12.3. Analysis

Comparison 12 PHYSIOTHERAPY WITH ELECTRO MAGNETIC THERAPY VERSUS PHYSIOTHERAPY WITH NO ELECTRO MAGNETIC THERAPY, Outcome 3 Range of shoulder external rotation at 12 weeks.

12.4

12.4. Analysis

Comparison 12 PHYSIOTHERAPY WITH ELECTRO MAGNETIC THERAPY VERSUS PHYSIOTHERAPY WITH NO ELECTRO MAGNETIC THERAPY, Outcome 4 Range of shoulder internal rotation at 12 weeks.

12.5

12.5. Analysis

Comparison 12 PHYSIOTHERAPY WITH ELECTRO MAGNETIC THERAPY VERSUS PHYSIOTHERAPY WITH NO ELECTRO MAGNETIC THERAPY, Outcome 5 Pain at rest at 12 weeks.

12.6

12.6. Analysis

Comparison 12 PHYSIOTHERAPY WITH ELECTRO MAGNETIC THERAPY VERSUS PHYSIOTHERAPY WITH NO ELECTRO MAGNETIC THERAPY, Outcome 6 Pain on movement at 6 weeks.

12.7

12.7. Analysis

Comparison 12 PHYSIOTHERAPY WITH ELECTRO MAGNETIC THERAPY VERSUS PHYSIOTHERAPY WITH NO ELECTRO MAGNETIC THERAPY, Outcome 7 Pain on lying at 6 weeks.

13.1

13.1. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 1 Improvement in severity of main complaint at 3 weeks.

13.2

13.2. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 2 Improvement in severity of main complaint at 7 weeks.

13.3

13.3. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 3 Improvement in severity of main complaint at 13 weeks.

13.4

13.4. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 4 Improvement in severity of main complaint at 26 weeks.

13.5

13.5. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 5 Improvement in severity of main complaint at 52 weeks.

13.6

13.6. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 6 Pain at 2‐3 weeks (100cm VAS).

13.7

13.7. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 7 Improvement in severity of day pain at 7 weeks.

13.8

13.8. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 8 Improvement in severity of day pain at 13 weeks.

13.9

13.9. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 9 Improvement in severity of day pain at 26 weeks.

13.10

13.10. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 10 Improvement in severity of day pain at 52 weeks.

13.11

13.11. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 11 Improvement in severity of night pain at 3 weeks.

13.12

13.12. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 12 Improvement in severity of night pain at 7 weeks.

13.13

13.13. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 13 Improvement in severity of night pain at 13 weeks.

13.14

13.14. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 14 Improvement in severity of night pain at 26 weeks.

13.15

13.15. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 15 Improvement in severity of night pain at 52 weeks.

13.16

13.16. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 16 Improvement in severity as rated by observer at 3 weeks.

13.17

13.17. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 17 Improvement in severity as rated by observer at 7 weeks.

13.18

13.18. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 18 Improvement in severity as rated by observer at 26 weeks.

13.19

13.19. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 19 Improvement in rating of shoulder disability at 3 weeks.

13.20

13.20. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 20 Improvement in rating of shoulder disability at 7 weeks.

13.21

13.21. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 21 Improvement in rating of shoulder disability at 13 weeks.

13.22

13.22. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 22 Improvement in rating of shoulder disability at 26 weeks.

13.23

13.23. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 23 Improvement in rating of shoulder disability at 52 weeks.

13.24

13.24. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 24 Range of abduction (degrees) at 2‐3 weeks.

13.25

13.25. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 25 Improvement in degree of restriction of ROM of abduction at 7 weeks.

13.26

13.26. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 26 Improvement in degree of restriction of ROM of abduction at 26 weeks.

13.27

13.27. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 27 Improvement in degree of restriction of ROM of ER at 3 weeks.

13.28

13.28. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 28 Improvement in degree of restriction of ROM of ER at 7 weeks.

13.29

13.29. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 29 Improvement in degree of restriction of ROM of ER at 26 weeks.

13.30

13.30. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 30 Number needing additional treatment at 7 weeks.

13.31

13.31. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 31 Frequency of adverse reactions.

13.32

13.32. Analysis

Comparison 13 INTRA‐ARTICULAR STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION, EXERCISE AND ELECTROTHERAPY), Outcome 32 Short term treatment success.

14.1

14.1. Analysis

Comparison 14 INTRA‐ARTICULAR AND SUBACROMIAL STEROID INJECTION VERSUS PHYSIOTHERAPY (EXERCISES AND ELECTROTHERAPY), Outcome 1 Pain at end of intervention period.

14.2

14.2. Analysis

Comparison 14 INTRA‐ARTICULAR AND SUBACROMIAL STEROID INJECTION VERSUS PHYSIOTHERAPY (EXERCISES AND ELECTROTHERAPY), Outcome 2 "Cured" at 5 weeks (participant rated).

14.3

14.3. Analysis

Comparison 14 INTRA‐ARTICULAR AND SUBACROMIAL STEROID INJECTION VERSUS PHYSIOTHERAPY (EXERCISES AND ELECTROTHERAPY), Outcome 3 "Not cured" (participant rated) at 2 and a half years (in those followed up).

15.1

15.1. Analysis

Comparison 15 INTRA‐ARTICULAR AND SUBACROMIAL STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION AND MANIPULATION), Outcome 1 Pain at end of intervention period.

15.2

15.2. Analysis

Comparison 15 INTRA‐ARTICULAR AND SUBACROMIAL STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION AND MANIPULATION), Outcome 2 "Cured" at 5 weeks (participant rated).

15.3

15.3. Analysis

Comparison 15 INTRA‐ARTICULAR AND SUBACROMIAL STEROID INJECTION VERSUS PHYSIOTHERAPY (MOBILISATION AND MANIPULATION), Outcome 3 "Not cured" (participant rated) at 2 and a half years (in those followed up).

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References

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Ebenbichler 1999 {published data only}
    1. Ebenbichler GR, Erdogmus CB, Resch KL, Funovics MA, Kainberger F, Barisani G, et al. [Ultrasound therapy for calcific tendinitis of the shoulder]. New England Journal of Medicine 1999;340:1533‐8. - PubMed
England 1989 {published data only}
    1. England S, Farrell A, Coppock J, Struthers G, Bacon P. [Low laser therapy of shoulder tendonitis]. Scandanavian Journal of Rheumatology 1989;18:427‐43. - PubMed
Ginn 1997 {published data only}
    1. Ginn KA, Herbert RD, Khouw W, Lee R. [A randomized, controlled clinical trial of a treatment for shoulder pain]. Physical Therapy 1997;77(8):802‐811. - PubMed
Herrera‐Lasso 1993 {published data only}
    1. Herrera‐Lasso I, Moborak L, Fernandez‐Dominguez L, Cardiel M, Alarcon‐Segovia D. [Comparative effectiveness of packages of treatment including ultrasound or transcutaneous electrical nerve stimulation in painful shoulder syndrome]. Physiotherapy 1993;79(4):251‐253.
Leclaire 1991 {published data only}
    1. Leclaire R, Bourgouin J. [Electromagnetic treatment of shoulder periarthritis: a randomised controlled trial of efficiency and tolerance of magnetotherapy]. Archives of Physical Medicine & Rehabilitation 1991;72:284‐288. - PubMed
Lee 1973 {published data only}
    1. Lee M, Haq A, Wright V, Longton E. [Periarthritis of the shoulder: A controlled trial of physiotherapy]. Physiotherapy 1973;59(10):312‐315. - PubMed
Nicholson 1985 {published data only}
    1. Nicholson G. [The effects of passive joint mobilisation on pain and hypomobility associated with adhesive capsulitis of the shoulder]. Journal of Orthopaedic & Sports Physical Therapy 1985;6:238‐246. - PubMed
Nykanen 1995 {published data only}
    1. Nykanen M. [Pulsed ultrasound treatment of the painful shoulder: A randomized, double‐blind, placebo‐controlled study]. Scandinavian Journal of Rehabilotation Medicine 1995;27:105‐108. - PubMed
Perron 1997 {published data only}
    1. Perron M, Malouin F. [Acetic acid iontophoresis and ultrasound for the treatment of calcifying tendinitis of the shoulder: A randomized control trial]. Archives of Physical Medicine and Rehabilitation 1997;78:379‐384. - PubMed
Reid 1996 {published data only}
    1. Reid D, Saboe L, Chepeha J. [Anterior shoulder instability in athletes: comparison of isokinetic resistance exercises and an electromyographic biofeedback re‐education program ‐ a pilot program]. Physiotherapy Canada 1996;48(4):251‐256.
Saunders 1995 {published data only}
    1. Saunders L. [The efficacy of low level laser therapy in supraspinatus tendinitis]. Clinical Rehabilitation 1995;9:126‐34.
Shehab 2000 {published data only}
    1. Shehab D, Adham N. [Comparative effectiveness of ultrasound and transcutaneous electrical stimulation in treatment of periarticular shoulder pain]. Physiotherapy Canada 2000;52(3):208‐210, 214.
Taverna 1990 {published data only}
    1. Taverna E, Parrini M, Cabitza P. Laser therapy versus placebo in the treatment of some bone and joint pathology [Laserterapia IR versus placebo nel trattamento di alcune patologie a carcio dell'apparato locomotore]. Minerva Ortopedica E Traumatologica 1990;41:631‐6.
van der Heijden 1999 {published data only}
    1. Heijden GJMG, Leffers P, Wolters PJMC, Verheijden JJD, Mameren HHJP, Bouter LM, Knipschild PG. [No effect of bipolar interferential electrotherapy and pulsed ultrasound for soft tissue shoulder disorders: a randomised controlled trial]. Annals of Rheumatic Diseases 1999;58(9):530‐540. - PMC - PubMed
    1. Heijden GJMG, Windt DAWM. [Shoulder disorders in primary care: prognosis and management]. Dutch Journal of Physical Therapy 1999;May:19‐22.
van der Windt 1998 {published data only}
    1. Windt DAWM, Koes BW, Deville W, Boeke QAJP, Jong BA, Bouter LM. [Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care: randomised trial]. British Medical Journal 1998;317(7168):1292‐1296. - PMC - PubMed
Vecchio 1993 {published data only}
    1. Vecchio P, Cave C, King V, Adebajo AO, Smith M, Hazleman BL. [A double‐blind study of the effectiveness of low level laser treatment of rotator cuff tendinitis]. British Journal of Rheumatology 1993;32(740‐42). - PubMed
Winters 1997/9 {published data only}
    1. Winters JC, Jorritsma W, Groenier KH, Sobel JS, Meyboom‐de‐Jong B, Hans J. [Treatment of shoulder complaints in general practice: long term results of a randomised, single blind study comparing physiotherapy, manipulation, and corticosteroid injection]. British Medical Journal 1999;318(7195):1395‐1396. - PMC - PubMed
    1. Winters JC, Sobel JS, Groenier KH, Arendzen HJ, Meyboom‐de‐jong, B. [Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: Randomized, single blind study]. British Medical Journal 1997;314:1320‐1325. - PMC - PubMed
    1. Winters JC, Sobel JS, Groenier KH, et al. [Comparison of physiotherapy, manipulation and corticosteroid injection for treating shoulder complaints in general practice]. Journal of Family Practice (Journal Club) 1997;45(2):103‐4. - PMC - PubMed

References to studies excluded from this review

Anderson 1996 {published data only}
    1. Anderson NH, Johannsen HV. Sneppen O. [Self‐training versus physiotherapist guided rehabilitation after arthroscopic deconmpression‐ a prospective randomized study]. Acta Orthopaedica Scandinavica 1996;Suppl 272:67.
Arciero 1994 {published data only}
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Arslan 2001 {published data only}
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Biswas 1979 {published data only}
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Echternach 1966 {published data only}
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Gam 1998 {published data only}
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Hagberg 2000 {published data only}
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Inaba 1972 {published data only}
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Lastayo 1998 {published data only}
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Leandri 1990 {published data only}
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Leboeuf 1987 {published data only}
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Livesley 1992 {published data only}
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Lloyd‐Roberts 1959 {published data only}
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Lundberg 1979 {published data only}
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Lundblad 1999 {published data only}
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Melzer 1995 {published data only}
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Meyer 1997 {published data only}
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Morgan 1995 {published data only}
    1. Morgan B, Jones A, Mulcahy K, Finlay D, Collett B. [Transcutaneous electric nerve stimulation (TENS) during distension shoulder arthrography: a controlled trial]. Pain 1995;64:265‐267. - PubMed
Nash 1990 {published data only}
    1. Nash TP, Williams JD, Machin D. [TENS: Does the type of stimulus really matter?]. Pain Clinic 1990;3:161‐168.
Partridge 1990 {published data only}
    1. Partridge CJ, Edwards SM, Mee R, Langenberghe HVK van. [Hemiplegic shoulder pain: a study of two methods of physiotherapy treatment]. Clinical Rehabilitation 1990;4:43‐9.
Philipson 1983 {published data only}
    1. Philipson T, Haagensen N, Laumann V, Nies M, Thorup K, Hansen TI. [The effect of diadynamic current on chronic soft tissue pain in the neck and shoulder girdle]. Ugeskr Laeger 1983;145(7):479‐481. - PubMed
Quin 1965 {published data only}
    1. Quin CE. [Frozen shoulder: Evaluation of tretment with hydrocortisone injections and exercises]. Annals of Physical Medicine 1965;8:22‐29. - PubMed
Raab 1996 {published data only}
    1. Raab M, Rzeszutko D, O'Connor W, Greatting M. [Early results of continuous passive motion after rotator cuff repair: a prospective, randomised, blinded, controlled study]. American Journal of Orthopaedics 1996;25(3):214‐220. - PubMed
Rahme 1998 {published data only}
    1. Rahme H, Solem‐Bertoft E, Westerberg CE, Lundberg E, Sorensen S, Hilding S. [The subacromial impingement syndrome. A study of results of treatment with special emphasis on predictive factors and pain‐generating mechanisms]. Scandinavian Journal of Rehabilitative Medicine 1998;30(4):253‐62. - PubMed
Randlov 1998 {published data only}
    1. Randlov A, Ostergaard M, Manniche C, Kryger P, et al. [Intensive dynamic training for females with chronic neck/ shoulder pain. A randomised controlled trial]. Clinical Rehabilitation 1998;12:200‐210. - PubMed
Ritchie 1997 {published data only}
    1. Ritchie, ED, Tong, D, Chung, F, Norris, A, Miniaci, A, & Vairavanathan, S. D. [Suprascapular nerve block ‐ A new technique for pain relief in arthroscopic shoulder surgery?]. The Journal of Bone and Joint Surgery ‐ British Volume 1997;79B(supp. 1):72‐73.
Rizk 1983 {published data only}
    1. Rizk T, Christopher R, Pinals R. [Adhesive Capsulitis (Frozen Shoulder): A new approach to its management]. Archives of Physical Medicine & Rehabilitation 1983;64:29‐33. - PubMed
Speer 1996 {published data only}
    1. Speer K, Warren R, Horowitz. [The efficacy of cryotherapy in post‐operative shoulder]. Journal of Shoulder & Elbow Surgery 1996;5:62‐8. - PubMed
Spence 1995 {published data only}
    1. Spence SH, Sharpe L, Newton‐John T, Champion D. [Effect of EMG biofeedback compared to applied relaxation training with chronic, upper extremity cumulative trauma disorders]. Pain 1995;63:199‐206. - PubMed
Vasseljen 1998 {published data only}
    1. Vasseljen O, Johansen B, Westgaard R. [The effect of pain reduction on perceived tension and EMG recorded trapezius muscle activity in workers with shoulder and neck pain]. Scandinavian Journal of Rehabilitation Medicine 1995;27:243‐252. - PubMed
Vecchini 1984 {published data only}
    1. Vecchini L, Grossi E. [Ionisation with diclofenac sodium in rheumatic disorders: A double blind placebo controlled trial]. Journal of International Medical Research 1984;12:346‐350. - PubMed
Waldburger 1992 {published data only}
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Waling 2000 {published data only}
    1. Waling K, Sundelin G, Ahlgren C, Jarvholm B. [Perceived pain before and after three exercise program ‐ a controlled clinical trial of women with work related trapezius myalgia]. Pain 2000;85(1‐2):201‐207. - PubMed
Williams 1986 {published data only}
    1. Williams J, Harvey J, Tannenbaum H. [Use of superficial heat versus ice for rheumatoid arthritic shoulder. A pilot study]. Physiotherapy Canada 1986;38:8‐13.
Wolf 1996 {published data only}
    1. Wolf M, Gomez R. [Independent home therapy versus formal physical therapy following arthroscopic shoulder surgery]. American Academy of Orthopaedic Surgeons: Scientific Program. Abstract in Orthopaedic Transactions 1996;20:20.

References to studies awaiting assessment

Chard 1988 {published data only}
    1. Chard MD, Hazleman BL, Devereaux MD. Controlled trial to investigate dose‐response patterns to portable, pulsed electromagnetic fields in the treatment of rotator cuff tendinitis: a review trial. J Orthop Rheumatol 1988;1:33‐40.
Gudmundsen 1987 {published data only}
    1. Gudmundsen J, Vikne J. Laser treatment for epicondylitis humeri and rotator cuff syndrome. Nord Tidsskr Idrettsmed 1987;2:6‐15.
Knorre 1990 {published data only}
    1. Knorre, von B, Keitel, W. [Vergleichende Therapiestudie: Ultraschall, Kryotherapie und intraartikulare Kortisonoide bei Veranderungen des Schultergelenkes aus entzundlicher Ursache]. Z. Physiother. Jg. 1990;42:221‐225.

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References to other published versions of this review

Green 1998
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