Oral steroids for adhesive capsulitis
Abstract
Background
This review is one in a series of Cochrane reviews of interventions for shoulder pain in adults.
Objectives
To determine the efficacy and safety of oral steroids for adhesive capsulitis.
Search methods
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.
Selection criteria
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.
Main results
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.
Authors' conclusions
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.
PICOs
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.
