Systematic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy

Abstract

Abstract Objective: To review the efficacy of common interventions for shoulder pain. Design: All randomised controlled trials of non-steroidal anti-inflammatory drugs, intra-articular and subacromial glucocorticosteroid injection, oral glucocorticosteroid treatment, physiotherapy, manipulation under anaesthesia, hydrodilatation, and surgery for shoulder pain that were identified by computerised and hand searches of the literature and had a blinded assessment of outcome were included. Main outcome measures: Methodological quality (score out of 40), selection criteria, and outcome measures. Effect sizes were calculated and combined in a pooled analysis if study population, end point, and intervention were comparable. Results: Thirty one trials met inclusion criteria. Mean methodological quality score was 16.8 (9.5-22). Selection criteria varied widely, even for the same diagnostic label. There was no uniformity in the outcome measures used, and their measurement properties were rarely reported. Effect sizes for individual trials were small (range −1.4 to 3.0). The results of only three studies investigating “rotator cuff tendinitis” could be pooled. The only positive finding was that subacromial steroid injection is better than placebo in improving the range of abduction (weighted difference between means 35° (95% confidence interval 14 to 55)). Conclusions: There is little evidence to support or refute the efficacy of common interventions for shoulder pain. As well as the need for further well designed clinical trials, more research is needed to establish a uniform method of defining shoulder disorders and developing outcome measures which are valid, reliable, and responsive in affected people. Key messages This systematic review found little evidence to support the use of any of the common interventions in managing shoulder pain There is currently no uniformity in the way shoulder disorders are labelled or defined Measurement of outcome varies widely between clinical trials and, in general, the reliability, validity, and responsiveness of these outcome measures are not established Further clinical trials are needed to determine the optimal treatment strategies for shoulder pain