Buchbinder R, Green S, Youd J M
Department of Clinical Epidemiology, Cabrini Hospital and Monash Unversity, Suite 41, Cabrini Medical Centre, 183 Wattletree Rd, Malvern, Victoria, Australia, 3144.
Cochrane Database Syst Rev. 2003;2003(1):CD004016. doi: 10.1002/14651858.CD004016.
While many treatments, including corticosteroid injections in and around the shoulder, are advocated to be of benefit for shoulder pain, few are of proven efficacy. This review of corticosteroid injections for shoulder pain is one in a series of reviews of varying interventions for shoulder disorders.
To determine the efficacy and safety of corticosteroid injections in the treatment of adults with shoulder pain.
MEDLINE, EMBASE, CINAHL, Central and Science Citation Index were searched up to and including June 2002.
Randomised and pseudo-randomised trials in all languages of corticosteroid injections compared to placebo or another intervention, or of varying types and dosages of steroid injection in adults with shoulder pain. Specific exclusions were duration of shoulder pain less than three weeks, rheumatoid arthritis, polymyalgia rheumatica and fracture.
Trial inclusion and methodological quality was assessed by two independent reviewers according to predetermined criteria. Results are presented separately for rotator cuff disease, adhesive capsulitis, full thickness rotator cuff tear and mixed diagnoses, and, where possible, combined in meta-analysis.
Twenty-six trials met inclusion criteria. The number, site and dosage of injections varied widely between studies. The number of participants per trial ranged from 20 to 114 (median 52 participants). Methodological quality was variable. For rotator cuff disease, subacromial steroid injection was demonstrated to have a small benefit over placebo in some trials however no benefit of subacromial steroid injection over NSAID was demonstrated based upon the pooled results of three trials. For adhesive capsulitis, two trials suggested a possible early benefit of intra-articular steroid injection over placebo but there was insufficient data for pooling of any of the trials. One trial suggested short-term benefit of intra-articular corticosteroid injection over physiotherapy in the short-term (success at seven weeks RR=1.66 (1.21, 2.28).
REVIEWER'S CONCLUSIONS: Despite many RCTs of corticosteroid injections for shoulder pain, their small sample sizes, variable methodological quality and heterogeneity means that there is little overall evidence to guide treatment. Subacromial corticosteroid injection for rotator cuff disease and intra-articular injection for adhesive capsulitis may be beneficial although their effect may be small and not well-maintained. There is a need for further trials investigating the efficacy of corticosteroid injections for shoulder pain. Other important issues that remain to be clarified include whether the accuracy of needle placement, anatomical site, frequency, dose and type of corticosteroid influences efficacy.
虽然包括肩部及其周围注射皮质类固醇在内的许多治疗方法都被认为对肩部疼痛有益，但很少有方法被证实有效。本次关于肩部疼痛皮质类固醇注射的综述是一系列针对肩部疾病不同干预措施综述中的一篇。
确定皮质类固醇注射治疗成人肩部疼痛的疗效和安全性。
检索了截至2002年6月（包括该月）的MEDLINE、EMBASE、CINAHL、CENTRAL和科学引文索引。
所有语言的随机和半随机试验，比较皮质类固醇注射与安慰剂或其他干预措施，或比较成人肩部疼痛患者不同类型和剂量的类固醇注射。具体排除标准为肩部疼痛持续时间少于三周、类风湿性关节炎、风湿性多肌痛和骨折。
两名独立评审员根据预定标准评估试验纳入情况和方法学质量。结果分别针对肩袖疾病、粘连性关节囊炎、肩袖全层撕裂和混合诊断情况呈现，并在可能的情况下进行荟萃分析合并。
26项试验符合纳入标准。各研究之间注射的次数、部位和剂量差异很大。每项试验的参与者人数从20至114人不等（中位数为52名参与者）。方法学质量参差不齐。对于肩袖疾病，一些试验表明肩峰下注射类固醇比安慰剂有微小益处，但根据三项试验的汇总结果，未显示肩峰下注射类固醇比非甾体抗炎药更有益。对于粘连性关节囊炎，两项试验表明关节内注射类固醇可能比安慰剂有早期益处，但没有足够数据对任何一项试验进行汇总。一项试验表明关节内注射皮质类固醇在短期内比物理治疗更有益（七周时成功率RR = 1.66（1.21，2.28））。
尽管有许多关于肩部疼痛皮质类固醇注射的随机对照试验，但样本量小、方法学质量参差不齐和异质性意味着几乎没有总体证据可指导治疗。肩袖疾病肩峰下注射皮质类固醇和粘连性关节囊炎关节内注射可能有益，尽管其效果可能较小且维持不佳。需要进一步试验研究皮质类固醇注射治疗肩部疼痛的疗效。其他有待澄清的重要问题包括皮质类固醇的注射针放置准确性、解剖部位、频率、剂量和类型是否会影响疗效。
