Evidently Advent Day 9: best health evidence wrapped up for the festive season!

Frozen shoulder (adhesive capsulitis): it’s not just snowmen


Frozen shoulder, or adhesive capsulitis, is a common cause of shoulder stiffness and pain and can last for two or three years. There’s evidence from two recently updated Cochrane reviews on whether electrotherapy or manual therapy and exercise can help.

High quality evidence showed that:

  • following arthrographic joint distension, the combination of manual therapy and exercise does not improve pain or function more than sham ultrasound, but may provide greater patient-reported treatment success and active range of motion

Moderate or low quality evidence suggested that:

  • low level laser therapy (LLLT) plus exercise for eight weeks may be more effective than exercise alone in terms of pain up to four weeks, and function up to four months
  •  LLLT for six days may be more effective than placebo in terms of overall treatment success at six days
  • it is unclear whether pulsed electromagnetic field therapy is more or less effective than placebo, or whether other electrotherapies are an effective addition to exercise
  • manual therapy and exercise probably improves pain and function less than glucocorticoid injection up to seven weeks
  • side effects were similar with manual therapy and exercise compared with glucocorticoid injection

More high quality randomised controlled trials are needed to establish the benefits and harms of electrotherapy, manual therapy and exercise compared to interventions with evidence of benefit, such as glucocorticoid injection or arthrographic joint distension.

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Page MJ, Green S, Kramer S, Johnston RV, McBain B, Buchbinder R. Electrotherapy modalities for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD011324. DOI: 10.1002/14651858.CD011324 – See more at: http://summaries.cochrane.org/CD011324/MUSKEL_electrotherapy-modalities-for-adhesive-capsulitis-frozen-shoulder#sthash.j8cGivfj.dpuf

Page MJ, Green S, Kramer S, Johnston RV, McBain B, Chau M, Buchbinder R. Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews 2014, Issue 8. Art. No.: CD011275. DOI: 10.1002/14651858.CD011275 – See more at: http://summaries.cochrane.org/CD011275/MUSKEL_manual-therapy-and-exercise-for-frozen-shoulder-adhesive-capsulitis#sthash.HtjuvQp5.dpuf

Sarah Chapman

About Sarah Chapman

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Sarah's work as a Knowledge Broker at Cochrane UK focuses on disseminating Cochrane evidence through social media, including Evidently Cochrane blogs, blogshots and the ‘Evidence for Everyday’ series for nurses, midwives, allied health professionals and patients. A former registered general nurse, Sarah has a particular interest making evidence accessible and useful to practitioners and to others making decisions about health. Before joining Cochrane, Sarah also worked on systematic reviews for the University of Oxford and the Royal College of Nursing Institute, and obtained degrees in History from the University of Oxford and in the history of women’s health and illness in early modern England (MPhil., University of Reading).

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