Six RCTs (256 participants) and five non-randomised studies (628 participants) were included in the review. All studies were classed as clinically relevant. All six RCTs were considered to be high quality, with all achieving at least eleven out of 12 criteria. One observational study was considered to be high quality and four were moderate quality. Follow-up in the trials ranged from one to 15 months; in the observational studies this was three months to 101 months.
Intra-articular injections (four studies, including one RCT)
Three studies showed positive results for pain relief and/or function. The RCT showed positive pain relief following prolotherapy (63.6%) compared with steroid injections (27.2%) at six months and 12 months (58.7% prolotherapy versus 10.2% steroid) follow-up. Overall, the authors concluded that the evidence was limited..
Periarticular injection (four studies, including three RCTs)
Three RCTs showed significant results for pain relief and function in favour of periarticular injection with steroids or botox in the short term (three months). Overall, the authors concluded that the evidence was limited.
Cooled radiofrequency neurotomy (two RCTs)
Pain relief and function were improved across three to 12 months follow-up (where reported), when compared with placebo. The authors concluded that the evidence was fair.
Conventional radiofrequency neurotomy and pulsed radiofrequency neurotomy were each evaluated by one observational study. Results were positive up to six months follow-up.The authors concluded that the evidence was limited.
Other secondary outcomes were not reported.