CLINICAL QUESTION

Do intra-articular steroid injections improve pain and function in patients with adhesive capsulitis, also known as frozen shoulder?

EVIDENCE-BASED ANSWER

Intra-articular steroid injections inconsistently improve pain and function when used to treat adhesive capsulitis in the short term (less than 12 weeks) and medium term (less than 6 months). (Strength of Recommendation [SOR]: A, multiple meta-analyses, systematic review.) Ultrasound guidance improves accuracy of injection into the glenohumeral joint, but there is no difference in pain at 3, 6, and 12 weeks compared with landmark-guided injection. (SOR: B, single randomized controlled trial [RCT].)

EVIDENCE SUMMARY

A 2020 systematic review and meta-analysis of 65 randomized trials compared the relative effectiveness of nonsurgical treatments for adhesive capsulitis.¹ The systematic review included studies that were randomized designs of any type comparing treatment modalities with placebo injection, no treatment, or other treatment modalities. Primary outcomes were pain and function, and the secondary outcome was shoulder external rotation range of motion (ROM). Pain was evaluated using a 0- to 10-point visual analog scale (VAS), with lower numbers indicating less pain. Because the studies used different functional scores, standardized mean differences were used in the overall analysis. Shoulder external rotation ROM was measured in degrees. Minimal clinically important differences were defined as 1 point for VAS pain, an effect size of 0.45 for functional score, and 10 degrees for ROM.