Study backs steroid injections in frozen shoulder

THE most effective treatment for frozen shoulder remains in question, though evidence confirms steroid injections and laser therapy provide important short-term benefits.

While admitting there was a lack of long-term, high-quality trials of treatments for frozen shoulder, Dutch experts have reported there was enough evidence to guide the choice of most effective short- and medium-term treatments.

An analysis of five Cochrane reviews and 18 randomised trials found strong evidence for the short-term efficacy of steroid injections and laser therapy.

Mobilisation techniques such as physiotherapy proved to be moderately effective in the long term, while the surgical approach of arthrographic distension alone, or in addition to physiotherapy, was effective in the short term.

Oral steroids showed modest efficacy over no treatment or placebo, and suprascapular nerve block was more effective than acupuncture, placebo or steroid injections. Evidence for the use of NSAIDs was lacking, the authors said.

Professor Rachelle Buchbinder, director of the Monash department of clinical epidemiology at Melbourne’s Cabrini Hospital, said the study suggested different treatments might work best at different stages of the condition.

“There is a paucity of head-to-head studies, and some treatments might work better in combination or sequentially,” she said.

“NSAIDs are often used first line, but... there is little empirical data for NSAIDs for this condition.

“Steroid injections do not [always] appear to be as effective as arthrographic distension with steroid and saline; and the evidence for laser therapy is conflicting at best,” she said.

Br J Sports Med, online 20 July