Study designs of evaluations included in the review
Randomised controlled trials (RCTs) were eligible for inclusion.
Specific interventions included in the review
Studies of multiple steroid injections were eligible for inclusion. The comparison groups in the included studies were different doses of steroid, different methods of steroid injection, physiotherapy, manipulation, ice therapy, stellate ganglion block, placebo or no treatment, and distension with steroid. Steroid treatment consisted of: triamcinalone acetonide, prednisolone acetate, triamcinalone acetonide, methyl prednisone acetate and hydrocortisone acetate at varying doses. The injections were administered intra-articularly or subacomially and the number of injections ranged from 2 to 6, with treatment periods ranging from 2 to 12 weeks. Various cointerventions were used (data not reported).
Participants included in the review
Studies of adults with adhesive capsulitis were eligible for inclusion. Studies of patients with conditions of the shoulder other than adhesive capsulitis were excluded. Studies of patients younger than 18 years of age were excluded. The four high-quality studies included patients with significant loss of passive external rotation and severe shoulder pain. Some studies excluded patients with bilateral symptoms, diabetes, previous treatment and neurological symptoms. Across studies, the mean age of the patients ranged from 47 to 56 years and 38 to 67% were female. The duration of symptoms ranged from 8 to 32 weeks. The studies were conducted in out-patient departments and general practice in Europe and the USA.
Outcomes assessed in the review
Inclusion criteria were not specified in terms of the outcomes. The outcomes assessed and methods of measurement varied between studies, although all assessed pain and range of movement at the glenohymera joint; some also assessed symptoms, disability, sleep function, functional ability and analgesic use. The duration of follow-up ranged from 6 to 52 weeks.
How were decisions on the relevance of primary studies made?
Two reviewers independently assessed studies for inclusion.