Effectiveness of Glenohumeral Joint Dilatation for Treatment of Frozen Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

The objective was to explore the effectiveness of glenohumeral joint distension for the treatment of frozen shoulder. We searched electronic data sources including PubMed, Scopus, and Embase from the earliest records available to February 2017. Eleven randomized controlled trials including at least one pair of comparisons between capsular distension and a reference treatment were included, comprising 747 participants. Patients' characteristics, details of reference treatments, aspects of capsular distension therapy, and outcome measurement were evaluated at three points in time: baseline, early following intervention, and at the trial's end. The primary and secondary outcomes were the between-group standardized mean differences of changes in shoulder function and range of motion, respectively. Regarding the long-term primary outcome, the superiority of capsular distension to reference treatments was not identified. One secondary outcome (external rotation limitation) showed a probable early positive response to capsular distension when compared to intra-articular corticosteroid injection. Aspects of approaches, imaging guiding techniques and doses of distension were not found to modify treatment effectiveness. In conclusion, distension of the glenohumeral joint provides a similar long-term efficacy to all reference treatments. A single dose of a corticosteroid-contained regimen introduced through the ultrasound-guided posterior approach is a preferable practice of capsular distension for the management of frozen shoulder.

Figure 1

Flow diagram for the study selection process based on the suggestion format of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Figure 2

Summary graph (A) and table (B) of risk of bias.

Figure 3

Forest plot of standardized mean differences of shoulder function improvement comparing hydrodilatation and intra-articular corticosteroid injection early following intervention (A) and at the trial’s end (B). Abbreviations: hydrodilatation, HD; intra-articular, IA. *denotes the regimen using hyaluronic acid instead of corticosteroid.

Figure 4

Forest plot of standardized mean differences of improvements in external rotation with use of hydrodilatation or an intra-articular corticosteroid injection early following intervention (A) and at the trial’s end (B). Abbreviations: hydrodilatation, HD; intra-articular, IA. *denotes the distension fluid that used hyaluronic acid instead of corticosteroid; ^#denotes the distension fluid that did not contain corticosteroid.

Figure 5

Forest plot of standardized mean differences of improvements in shoulder function comparing the use of hydrodilatation and various reference treatments early following intervention (A) and at the trial’s end (B). Abbreviations: hydrodilatation, HD; Placebo, PLA; IM, intensive manipulation; GPT, general physical therapy; TAU, treatment as usual; SAI, subacromial injection.

Figure 6

Forest plot of standardized mean differences of improvement in internal rotation with the use of hydrodilatation and/or various reference treatments early following intervention (A) and at the trial's end (B). Abbreviation: hydrodilatation, HD; TAU, treatment as usual; SAI, subacromial injection.