Arthrographic distension for adhesive capsulitis (frozen shoulder)
Editorial Group: Cochrane Musculoskeletal Group
Published Online: 23 JAN 2008
Assessed as up-to-date: 18 OCT 2007
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Buchbinder R, Green S, Youd JM, Johnston RV, Cumpston M. Arthrographic distension for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD007005. DOI: 10.1002/14651858.CD007005.
- Publication Status: Edited (no change to conclusions)
- Published Online: 23 JAN 2008
Adhesive capsulitis (frozen shoulder or painful stiff shoulder) is characterised by spontaneous onset of shoulder pain accompanied by progressive stiffness and disability. It is usually self-limiting but often has a prolonged course over two to three years.
To determine the effectiveness and safety of arthrographic distension of the glenohumeral joint in the treatment of adults with adhesive capsulitis.
We searched the Cochrane Musculoskeletal Review Group Register, CENTRAL, MEDLINE, CINAHL, and EMBASE to November 2006, unrestricted by date or language.
We included randomised controlled trials and controlled clinical trials comparing arthrographic distension with placebo or other interventions.
Data collection and analysis
Two review authors independently assessed study quality and extracted data.
Five trials with 196 people were included. One three-arm trial (47 participants) compared arthrographic distension using steroid and air to distension using air alone and to steroid injection alone. One trial (46 participants) compared arthrographic distension using steroid and saline to placebo. Two trials (45 and 22 participants) compared arthrographic distension using steroid to steroid injection alone. One trial (36 participants) compared arthrographic distension using steroid and saline plus physical therapy to physical therapy alone. Trials included similar study participants, but quality and reporting of data were variable. Only one trial was at low risk of bias. No meta-analysis was performed.
The trial with low risk of bias demonstrated that distension with saline and steroid was better than placebo for pain (number needed to treat to benefit (NNTB) = 2), function (NNTB = 3) and range of movement at three weeks. This benefit was maintained at six and 12 weeks only for one of two scores measuring function (NNT = 3). A second trial with high risk of bias also reported that distension combined with physical therapy improved range of movement and median percent improvement in pain (but not pain score) at eight weeks compared to physical therapy alone. Three further trials, all at high risk of bias, reported conflicting, variable effects of arthrographic distension with steroid compared to distension alone, and arthrographic distension with steroid compared to intra-articular steroid injection. The trials reported a small number of minor adverse effects, mainly pain during and after the procedure.
There is "silver" level evidence that arthrographic distension with saline and steroid provides short-term benefits in pain, range of movement and function in adhesive capsulitis. It is uncertain whether this is better than alternative interventions.
Plain language summary
Arthrographic distension for adhesive capsulitis (frozen shoulder)
This summary of a Cochrane review presents what we know from research about the effect of arthrographic distension for adhesive capsulitis. In people with adhesive capsulitis;
Undergoing distension with steroid and saline solution compared to placebo (fake distension);
- May improve pain at three weeks.
- May improve disability at three, six and 12 weeks.
Undergoing distension with steroid and saline solution compared to ordinary injection with steroid;
- May not lead to any difference in pain and disability.
We often do not have precise information about side effects and complications. Possible minor side effects may include pain or claustrophobia at the time of the procedure and fluid noises in the shoulder.
What is adhesive capsulitis and what is arthrographic distension?
Another name for adhesive capsulitis is "frozen shoulder" or "painful stiff shoulder". In fact, it is so painful and stiff, it becomes difficult to move your shoulder in a normal way. Sometimes the loss of movement to your shoulder makes it feel like it is completely frozen. It is thought to be caused by scar-like tissue (adhesions) forming in the shoulder joint. Arthrographic distension is a procedure where fluid is injected into the shoulder joint to break up the adhesions that might be restricting the shoulder's movement and causing disability. Depending on the treatment, the fluid might contain a saline solution or steroids.
Best estimate of what happens to people with adhesive capsulitis who have arthrographic distension:
Pain: at three weeks after treatment, people's pain improved by 2 points on a scale of 0-10. This could be as low as 1.1 or as high as 3.5 points on a scale of 1-10.
Disability: One study found that at three weeks after treatment, people's disability was improved by 11 points on a scale of 0-100, possibly as few as 4 or as many as 11 points on a scale of 0-100. Another study found disability was improved by 17 points. This improvement could possibly be as low as 6 or as many as 28 points on a scale of 0-100.
At six weeks after treatment, people's disability was improved by 46 points on a scale of 0-500. This improvement could possibly be as little as 20 points or as many as 80 points on a scale of 0-500.
At 12 weeks after treatment, people's disability was improved by 54 points on a scale of 0-500. This improvement could be as little as 15 points or as many as 95 points on a scale of 0-500.
The numbers given are our best estimate. When possible, we have also presented a range because there is a 95 percent chance that the true effect of the treatment lies somewhere between that range.
搜尋包括Cochrane Musculoskeletal Review Group Register, CENTRAL, MEDLINE, CINAHL, and EMBASE到2006年11月。
5個研究包含196例病患於分析中。1篇﹝47位病患﹞分3組的研究比較關節造影用類固醇及空氣去擴張比只用空氣去擴張和比上只用類固醇注射。1篇﹝46位病患﹞比較關節造影用類固醇及生理食鹽水與安慰劑。2篇(45及22位)關節造影用類固醇比上只用類固醇注射。1篇(36位病患)關節造影用類固醇及生理食鹽水加物理治療比上只用物理治療。研究病患數約相等，但品質及報告數據不一。只有一篇為低偏差風險。未作統合分析。低偏差風險研究顯示關節造影用類固醇及生理食鹽水比安慰劑在3週時，對疼痛有效(number needed to treat to benefit (NNTB) = 2)，功能(NNTB = 3)及關節活動度改善。測功能之兩個指標之一，其效果只維持在6及12週(NNT = 3)，另一高偏差風險研究顯示關節造影加物理治療比上只用物理治療，在8週時改善關節活動度，疼痛減輕百分比中位數﹝但非疼痛分數﹞。3篇高偏差風險研究顯示關節造影擴張用類固醇與否，及關節造影擴張用類固醇比上關節內類固醇注射，結果不一致。少部分有小的副作用(大多疼痛)發生於造影當時或之後。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
以關節造影擴張治療粘黏性關節囊炎(冰凍肩)。此Cochrane回顧摘要了我們所知道有關關節造影擴張治療粘黏性關節囊炎效果的研究。在粘黏性關節囊炎患者; 相比於安慰劑(假擴張)，使用類固醇和生理食鹽水擴張; 可以在3個星期後改善疼痛。在3，6和12週後改善失能。相比於注射類固醇，接受類固醇和生理鹽水擴張，可能在疼痛和失能不會導致任何的差異。我們往往沒有確切關於副作用和併發症的資訊。可能的副作用包括輕微疼痛或操作過程和肩膀液體噪音導致的幽閉恐懼症。什麼是粘黏性關節囊炎，什麼是關節造影擴張？粘黏性關節囊炎的另一個名字是“冰凍肩”或“痛苦僵硬的肩膀。”事實上，它是如此痛苦和僵硬，很難將您的肩膀用正常方式移動。有時你的肩膀喪失運動的感覺是像完全凍結住。它被認為是肩關節疤痕組織(粘粘)造成的。關節造影擴張是一個步驟把液體注入肩關節粘粘處，打破可能限制肩膀運動造成失能的粘粘。根據不同的治療，液體可能包含生理食鹽水或類固醇。關節造影擴張治療粘粘囊炎的患者最樂觀估計會發生什麼事：疼痛：在治療後3個星期，患者疼痛進步了2分(0 – 10分量表)。這可低至1.1或高達 3.5分的進步(10分量表). 失能：一項研究發現，在治療3個星期後，患者功能進步11分(1 – 100分量表)，這可低至4或高達11分的進步(1 – 100分量表)。另一項研究發現功能是進步了17分。這可低至6或高達28分的進步(1 – 100分量表)。治療 6週後，患者功能是進步了46分(0 – 500分量表)。這可低至20或高達80分的進步(0 – 500分量表)。在治療12週後，患者功能是進步了54分(0 – 500分量表)。這可低至15或高達95分的進步(0 – 500分量表). 該提供的數據是我們最好的估計。如果可能，我們也提出了一個範圍，因為有95% 的機會，真正的治療效果，介於這個範圍之間。