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Three Part Question

In [adult patients with acute frozen shoulder]
Is [acupuncture better than corticosteroid injection]
At [decreasing pain and improving range of movement]

Clinical Scenario

A 55 year old female patient presents to with a 7 week history of a gradual onset of pain and a range of movement limited in a capsular pattern confirming adhesive capsulitis. Her pain is limiting your treatment options to restore movement. You are unsure if a course of acupuncture or a corticosteroid injection may help to decrease her pain and assist with restoring her range of movement. You wonder if there is any evidence to help you choose.

Search Strategy

MEDLINE 1996-August 2011, CINAHL 1996 – August 2011, SPORTS DISCUS 1996- August 2011, In addition the Cochrane database, PEDro database, Association of Acupuncture Chartered Physiotherapists (AACP) and British Medical Acupuncture Society (BMAS) databases and google scholar were also searched.

Search String

(Frozen shoulder OR capsulitis OR adhesive capsulitis) AND (Acupuncture OR Acupressure OR Electroacupuncture OR Triggerpoint) AND (Corticosteroid OR Injection)

Limited to Human studies and English language in MEDLINE and CINAHL databases, limited to English language in all other database searches.

Search Outcome

This search retrieved no papers that were pertinent to the three part question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

A systematic review by Faverjee et al (2010) reported low quality evidence that acupuncture had a significant effect on pain and function in patients with acute frozen shoulder. They reported one high quality study with a significant difference in favour of acupuncture and exercises compared with exercises alone in treating chronic frozen shoulder. Four papers compared Corticosteroid injections to different modalities of physiotherapy. But the modalities were not specified and the studies did not show any significant differences in pain and range of movement outcome measures. Three high quality RCTs compared steroid injections with exercises and demonstrated significant benefit of intra-articular injection over physiotherapy alone on pain measure and one study showed that a combination of physiotherapy and steroid injection was more effective on improving range of movement than physiotherapy or steroid injection alone. However no study compared the efficacy of the two interventions of acupuncture or corticosteroid injection.

Clinical Bottom Line

There is no evidence to determine if acupuncture is better than a corticosteroid injection at decreasing pain and/or improving range of movement in adult patients with acute frozen shoulder.

References

1. Faverjee, M.M., Huisstede, B.M.A. and Koes, B.W. Frozen Shoulder: the effectiveness of conservative and surgical interventions – systematic review. British Journal of Sports Medicine 2011; 45: 49-56.