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A systematic review of treatment of frozen shoulder

by hydrodistension with or without steroid or intraarticular steroid injection

Raghavan, Roshan, MBBS, DOrtho, MRCS, FRCS(Tr&Orth)a; Dwyer, Amitabh J., MBBS, MS(Orth), FRCS(Tr&Orth)b

doi: 10.1097/BCO.0000000000000770
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Background: Hydrodistension is a popular mode of treatment for frozen shoulder. Hydrodistension of the shoulder joint capsule is either performed with or without use of a steroid. A simple intraarticular corticosteroid injection into the shoulder joint is also used in treatment of frozen shoulder. This article reviews randomized controlled studies that have shown and compared evidence on efficacy of these two treatment methods.

Methods: A systematic review of the literature was done using online database EMBASE, Pubmed, Cochrane database, Medline, and CINAHL. Only randomized studies that compared hydrodistension with or without steroid to intraarticular steroid injection alone were included.

Results: Of the five studies identified, three showed no difference between steroid injections alone when compared to distension with steroids. One showed better results with distension with steroid and with intraarticular steroid alone when compared with distension alone. One showed better results with distension with steroids than with intraarticular steroid alone at short-term follow-up of 3 mo.

Conclusions: Our systematic review demonstrated that patients treated by any of the three modalities improved with no significant difference among them over a period of 6 to 12 mo. However, at 3 mo distension with steroids and steroid injection alone were superior to distension alone.

aConsultant Orthopaedic Surgeon, Department of Trauma & Orthopaedic Surgery, Borders General Hospital, Huntlyburn, Melrose, Scotland, UK

bConsultant Orthopaedic Surgeon, Department of Trauma & Orthopaedic Surgery, Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Hinchingbrooke Park, Huntingdon, England, United Kingdom

Financial Disclosure: The authors report no conflicts of interest.

Correspondence to Amitabh J. Dwyer, MBBS, MS(Orth), FRCS(Tr&Orth), Consultant Orthopaedic Surgeon, Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Hinchingbrooke Park, Huntingdon PE29 6NT Tel: +0044-1480-442802; fax: +0044-1935-384800; e-mail: amitabhdwyer@yahoo.com.

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