Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.
Am J Sports Med. 2021 May;49(6):1669-1679. doi: 10.1177/0363546520956293. Epub 2020 Sep 17.
Frozen shoulder is a common shoulder disorder characterized by pain and restriction. Various nonsurgical treatments have been reported, but there is no consensus about their comparative efficacy and the effects of moderators.
To compare the efficacy of different nonsurgical interventions and identify potential patient-specific moderating factors for frozen shoulder.
Systematic review and network meta-analysis.
PubMed, Embase, Cochrane Library, and Web of Science databases were searched from their inception to February 18, 2019. The search was supplemented by manual review of relevant reference lists. Randomized controlled trials of participants with frozen shoulder that compared nonsurgical interventions were selected. Measured outcomes included pain, shoulder function in daily activities, and range of motion.
Of 3136 records identified, 92 trials were eligible, evaluating 32 nonsurgical interventions in 5946 patients. Intra-articular injection improved pain (pooled standardized mean difference [95% CI]: steroid injection, 1.68 [1.03-2.34]; capsular distension, 2.68 [1.32-4.05]) and shoulder function (steroid injection, 2.16 [1.52-2.81]; distension, 2.89 [1.71-4.06]) to a greater extent than placebo. Capsular distension and extracorporeal shockwave therapy showed the highest ranking for pain relief and functional improvement, respectively. Laser therapy also showed benefits for pain relief (3.02 [1.84-4.20]) and functional improvement (3.66 [1.65-5.67]). Subgroup analyses by disease stages revealed that steroid injection combined with physical therapy provided more benefits during the freezing phase, whereas joint manipulation provided more benefits in the adhesive phase. Adjunctive therapies, female sex, and diabetes were also identified as moderators of effectiveness.
Capsular distension is a highly recommended choice for treatment of frozen shoulder, contributing greatly to pain relief and functional improvement; steroid injection is also a prevailing effective intervention. Among new options, extracorporeal shockwave therapy and laser therapy show potential benefits for multiple outcomes. Individualized optimal intervention should be considered, given that treatment effect is moderated by factors including the disease stage, time of assessment, adjunctive therapies, female sex, and diabetes.
冻结肩是一种常见的肩部疾病，其特征为疼痛和活动受限。已有多种非手术治疗方法被报道，但对于这些方法的相对疗效和影响因素尚无共识。
比较不同非手术干预措施的疗效，并确定冻结肩的潜在患者特异性调节因素。
系统评价和网络荟萃分析。
从建库至 2019 年 2 月 18 日，检索 PubMed、Embase、Cochrane 图书馆和 Web of Science 数据库，并通过手工检索相关参考文献进行补充。纳入比较冻结肩非手术治疗的随机对照试验。测量结局包括疼痛、日常活动中的肩部功能和活动范围。
共 3136 条记录，92 项试验符合纳入标准，共纳入 5946 例患者的 32 种非手术干预措施。关节内注射在缓解疼痛（汇总标准化均数差[95%CI]：皮质类固醇注射，1.68[1.03-2.34]；囊扩张，2.68[1.32-4.05]）和肩部功能（皮质类固醇注射，2.16[1.52-2.81]；囊扩张，2.89[1.71-4.06]）方面优于安慰剂。囊扩张和体外冲击波疗法在缓解疼痛和改善功能方面的排名最高。激光治疗也显示出缓解疼痛（3.02[1.84-4.20]）和改善功能（3.66[1.65-5.67]）的益处。按疾病阶段的亚组分析显示，皮质类固醇注射联合物理治疗在冻结期更有益，而关节松动术在粘连期更有益。辅助治疗、女性和糖尿病也被确定为疗效的调节因素。
囊扩张是治疗冻结肩的首选方法，可显著缓解疼痛和改善功能；皮质类固醇注射也是一种有效的治疗方法。在新的治疗选择中，体外冲击波疗法和激光疗法在多个结局方面显示出潜在的益处。鉴于疾病阶段、评估时间、辅助治疗、女性和糖尿病等因素会影响治疗效果，应考虑个体化的最佳干预措施。
