Oral steroids for adhesive capsulitis
Editorial Group: Cochrane Musculoskeletal Group
Published Online: 18 OCT 2006
Assessed as up-to-date: 5 AUG 2006
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Buchbinder R, Green S, Youd JM, Johnston RV. Oral steroids for adhesive capsulitis. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD006189. DOI: 10.1002/14651858.CD006189.
- Publication Status: Edited (no change to conclusions)
- Published Online: 18 OCT 2006
This review is one in a series of Cochrane reviews of interventions for shoulder pain in adults.
To determine the efficacy and safety of oral steroids for adhesive capsulitis.
Searches of the Cochrane Library including CENTRAL, Issue 4, 2005, Cochrane Musculoskeletal Review Group Register, MEDLINE, EMBASE, CINAHL were conducted in November 2005, unrestricted by date or language.
Only studies described as randomised controlled trials studying participants with adhesive capsulitis, frozen shoulder, stiff painful shoulder or periarthritis and interventions of oral steroids compared to placebo, no treatment, or any other treatment were included.
Data collection and analysis
Two independent reviewers assessed methodological quality of each included trial and extracted data. Standard Cochrane methodology was used to analyse the extracted data.
Five small trials were included: two trials (30 and 49 participants) of oral steroids or placebo; one trial (40 participants) of oral steroids or no treatment; one trial (28 participants) of oral or intra-articular steroids; and one trial (32 participants) of manipulation under anaesthesia and intraarticular steroid injection with or without oral steroids. Study participants were similar across trials, but no trial used the same oral steroid regimen or dosage. Trials were of variable quality (only one of high quality) and some were poorly reported.
No meta-analyses could be performed as no raw data could be extracted from one placebo-controlled trial and three trials used different comparators. One trial reported significant short-term benefits of oral steroids versus placebo: 48% more participants reported success (RR = 2 (95% CI 1.3 to 3.1, NNT=2); overall improvement in pain 2.7 (95% CI 1.4 to 4.0) on a 0 to 10 point scale; total shoulder abduction increased by 23.3 degrees (95% CI 11.3 to 35.3); Shoulder Pain and Disability Index (SPADI) score improved by 18.1 (95% CI 7.6 to 28.6) on a 0 to 100 point scale. But benefits were not maintained at 6 weeks. A second trial reported no significant differences between oral steroid and placebo in pain or range of movement but it suggested improvement occurred earlier in the steroid treated group. A third trial reported that oral steroids provided a more rapid initial improvement in pain compared to no treatment but negligible differences by five months. There were minimal adverse effects reported.
Available data from two placebo-controlled trials and one no-treatment controlled trial provides "Silver" level evidence (www.cochranemsk.org) that oral steroids provides significant short-term benefits in pain, range of movement of the shoulder and function in adhesive capsulitis but the effect may not be maintained beyond six weeks.
Plain language summary
Oral steroids for shoulder pain (adhesive capsulitis)
This summary of a Cochrane review presents what we know from research about the effect of steroids taken as pills (oral) for adhesive capsulitis. The review shows that:
There is silver level evidence (www.cochranemsk.org) that oral steroids may work to treat shoulder pain (adhesive capsulitis) in the short term. Oral steroids may decrease pain and disability, and may improve movement in the shoulder in the short term. But the benefits of oral steroids may not last 6 weeks. Oral steroids taken for short periods in people who are otherwise healthy may not cause harms. There is not enough evidence to be certain of the benefits and harms of oral steroids and more research is needed.
What is adhesive capsulitis and what drugs are used to treat it?
Shoulder pain can be caused by a number of different conditions. It can be caused by rotator cuff disease or adhesive capsulitis (also called frozen shoulder, stiff painful shoulder or periarthritis). While both conditions are painful, adhesive capsulitis also tends to cause stiffness in the shoulder no matter which way you move it. The pain and stiffness in the shoulder can go away on its own but could last up to 2 to 3 years. Some people may still not be able to move their shoulder fully after 3 years.
Drug and non-drug treatments are used to relieve the pain and stiffness. In other arthritis diseases, steroids, taken as pills, have been shown to work. It is therefore thought that steroids, such as prednisolone or cortisone pills, may work for adhesive capsulitis.
What are the results of this review?
The studies tested people who had adhesive capsulitis for about 6 months. They were given no treatment, fake treatments, steroid injections or oral steroids. Oral steroids, such as prednisolone or cortisone were given for about 3 to 4 weeks, and sometimes again for another 3 to 4 weeks if people still had pain and stiffness. All people had physiotherapy or an exercise programme while taking the steroids.
Benefits of oral steroids
In people with adhesive capsulitis, at 3 weeks, oral steroids
may work more than fake pills
48 out of 100 people who took fake pills said they were better
96 out of 100 people who took steroids said they were better
may decrease pain and disability more than fake pills
pain may decrease by 2.7 more points on a scale of 0 to 10 with steroids
disability may decrease by 18 more points on a scale of 0 to 100 with steroids
may increase the ability to move the shoulder more than fake pills
shoulder movement increased by 23 degrees
But these benefits did not last as long as 6 weeks so there is not enough evidence to be certain of the results beyond 3 weeks.
Oral steroids may also improve pain earlier and quicker than no treatment at all. But after 5 months there were no benefits of oral steroids over no treatment. There is also not enough evidence to be certain of the results.
Harms of oral steroids
In people with adhesive capsulitis who have no serious other problems, taking oral steroids for a short time may not cause serious side effects. But there is not enough evidence to be certain. Other research about steroids taken over longer periods of time shows that harms could include high cholesterol and high blood pressure.
搜尋包括Cochrane Library including CENTRAL, Issue 4, 2005, Cochrane Musculoskeletal Review Group Register, MEDLINE, EMBASE, CINAHL到November 2005。
5個研究包含分析中，包括2篇口服類固醇治療比上安慰劑﹝30與49位患者﹞，1篇口服類固醇治療比上不治療﹝40位﹞，1篇口服或注射類固醇治療﹝28位﹞，1篇麻醉下徒手矯正治療及關節注射類固醇﹝32位﹞、加與不加口服類固醇。不同研究參加者相似，但無一研究劑量相同。研究品質不一﹝只有一篇高等級﹞，有些品質不佳。未進行統合分析，因無法由隨機對照試驗萃取資料，且3篇使用不同的比較標的。1篇報告口服類固醇比上不治療，顯示短期口服類固醇有效：多於48% 參與者(RR = 2 (95% CI 1.3 to 3.1, NNT = 2)報告成功；整體疼痛進步2.7 (95% CI 1.4 to 4.0)﹝0到10點評量﹞，整體肩部外展增加23.3度(95% CI 11.3 to 35.3)，肩痛及失能指標(SPADI) 分數進步18.1 (95% CI 7.6 to 28.6)﹝0到100點評量﹞。但效果無法維持6週。另一篇口服類固醇治療比上安慰劑在疼痛及關節活痛度改善不顯著，但口服類固醇治療組進步較早。第三篇報告口服類固醇治療比安慰劑可提供更迅速的初步疼痛緩解，但5個月時差異微小。極少報告副作用。 口服類固醇治療組進步較早。第三篇報告口服類固醇治療比安慰劑可提供更迅速的初步疼痛緩解，但5個月時差異微小。極少報告副作用。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
口服類固醇治療肩膀疼痛(粘黏性肩關節囊炎)此Cochrane review摘要了我們所知道有關類固醇藥丸(口服)治療粘黏性肩關節囊炎的效果。回顧表明：有銀級證據(www.cochranemsk.org)，短期口服類固醇治療可能可治療肩部疼痛(粘黏性肩關節囊炎)。口服類固醇可減少疼痛和失能，並且可以在短期內改善肩膀運動。但是，口服類固醇的好處可能不會持續 6週。採取短時間口服類固醇的人若是健康的，可能不會造成危害。沒有足夠的證據可以肯定口服類固醇的好處與壞處，還需要更多的研究。什麼是粘黏性肩關節囊炎，什麼藥物可用來治療呢？肩膀疼痛可能因一些不同情況所引起。它可能因旋轉肌疾病或粘黏性肩關節囊炎(又稱冰凍肩，肩膀僵硬疼痛或肩周炎)所引起。儘管這兩個原因都是疼痛的，粘黏性肩關節囊炎也往往會導致肩膀僵硬，無論用哪種方式都是難以移動肩膀。肩膀疼痛和僵硬可以自行消失，但可能長達 2至3年。但有些人經過3年可能仍然不能把他們的肩膀充分移動。藥物和非藥物治療可以緩解疼痛和僵硬。在其他關節炎疾病，類固醇作成藥片，已被證明有效果。因此被認為類固醇，Prednisolone或 cortisone的藥片，可能對粘黏性肩關節囊炎有效。這次review結果是什麼呢？該研究測試了粘黏性肩關節囊炎患者約 6個月。他們被給予了無治療，假治療，類固醇注射或口服類固醇。口服類固醇，如Prednisolone或 cortisone分別給予 3至4週，如果人們仍然感到疼痛和僵硬有時又另外多3至4週。所有的人在使用類固醇時，都會同時有物理治療或運動計劃。口服類固醇的好處在粘黏性肩關節囊炎患者，3週口服類固醇 ‧可比假藥丸有效每 100位使用假藥丸中有48位認為他們有改善每 100位使用類固醇中有96位認為他們有改善 ‧可減少疼痛和殘疾勝過假藥丸使用類固醇，疼痛可能會降低超過2.7分(0 – 10分量表) 使用類固醇，失能可減少 18分100量表) ‧可能會增加肩膀移動能力勝過假藥丸肩部運動增加了23度但這些好處並沒有持續超過 6週，所以我們沒有足夠的證據可以肯定超過 3週的結果。比起任何治療，口服類固醇也可較早較快改善疼痛。但經過 5個月，口服類固醇沒有任何好處會超過任何治療。還沒有足夠的證據可以肯定這些結果。口服類固醇的害處在沒有其他嚴重問題的粘黏性肩關節囊炎患者，很短時間服用口服類固醇，可能不會導致嚴重的副作用。但沒有足夠的證據可以肯定。其他有關類固醇使用較長時間的研究顯示，可能造成的傷害包括高膽固醇和高血壓。