Current management of shoulder adhesive capsulitis: a randomized, triple-blind placebo-controlled trial

Riyadh A. Almashni, Abdullah W. Calacattawi, Meshal A. Almeshal, Elaf J. Alsharif, Mohamad W. Hijazi, Shahd A. Abdulwahab, Anfal J. Alsharif, Nasser O. Altufayl, Anwar A. Alghamdi, Hisham A. Almuzayyen


This review is aiming to discuss both operative and non-operative current management of this adhesive capsulitis. The present review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) declaration standards for systematic reviews. A systematic search for the terms adhesive capsulitis, frozen shoulder, glucocorticoid, non-operative operative, current management, and management of systematic review in different databases, including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL), were searched up to March 2018 for published and unpublished studies and without language restrictions. The majority of the trials show level 2 [mid-level] evidence, positive results were found for intra-articular corticosteroid injections combined with shoulder mobility and stretching exercises are more effective in providing short-term (4-6 weeks) pain relief and improved function compared to shoulder mobility and stretching exercises alone. On the basis of current clinical evidence, this systematic review suggests that there is no strong evidence to support or refute the current practice in term of adhesive capsulitis management. As there is a need of further research in this issue and to have clear uniformed prospective about the adhesive capsulitis.


Adhesive capsulitis, Frozen shoulder, Intra-articular glucocorticoid, Operative management

Full Text:



Hand GC, Athanasou NA, Matthews T, Carr AJ. The pathology of frozen shoulder. J Bone Joint Surg Br. 2007;89(7):928–32.

Arkkila PE, Kantola IM, Viikari J.S, Rönnemaa T. Shoulder capsulitis in type I and II diabetic patients: association with diabetic complications and related diseases. Ann Rheum Dis. 1996;55(12):907-14.

Balci N, Balci MK, Tüzüner S. Shoulder adhesive capsulitis and shoulder range of motion in type II diabetes mellitus: association with diabetic complications. J Diabetes Complications. 1999;13(3):135-40.

Kang JH, Sheu JJ, Lin HC. Increased risk of stroke after adhesive capsulitis: a population-based study. Stroke. 2010;41(5):1044-7.

Neviaser RJ. The Journal of Musculoskeletal Medicine. Cliggott Publishing Company. 1992;9(2):62.

Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ. 2005;331:1453–6.

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 Syst Rev. 2014;26(8):CD011275.

Widiastuti-Samekto M, Sianturi GP. Frozen shoulder syndrome: comparison of oral route corticosteroid and intra-articular corticosteroid injection. Med J Malaysia. 2004;59(3):312-6.

Buchbinder R, Green S, Youd JM, Johnston RV. Oral steroids for adhesive capsulitis. Cochrane Database Syst Rev. 2006;(4):CD006189.

Grant JA, Schroeder N, Miller BS, Carpenter JE. Comparison of manipulation and arthroscopic capsular release for adhesive capsulitis: a systematic review. J Shoulder Elbow Surg. 2013;22(8):1135-45.

Mun SW, Baek CH. Clinical efficacy of hydrodistention with joint manipulation under interscalene block compared with intra-articular corticosteroid injection for frozen shoulder: a prospective randomized controlled study. J Shoulder Elbow Surg. 2016;25(12):1937-43.

Page MJ, Green S, Kramer S, Johnston RV, McBain B, Buchbinder R. Electrotherapy modalities for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev. 2014;(10):CD011324.

Yaying S, Peng Z, Shaohua L, Hong L, Jia J, Shiyi C, et al. Intra-articular Steroid Injection for Frozen Shoulder A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis. AJSM. 2016.

Prestgaarda T, Wormgoora MEA, Haugena S, Harstada H, Mowinckelc P, Broxd JI. Ultrasound-guided intra-articular and rotator interval corticosteroid injections in adhesive capsulitis of the shoulder: a double-blind, sham-controlled randomized study. PAIN. 2015;156:9.

Hsieh L-F, Hsu W-C, Lin Y-J, Chang H-L, Chen C-C, Huang V. Addition of Intra-articular Hyaluronate Injection to Physical Therapy Program Produces No Extra Benefits in Patients With Adhesive Capsulitis of the Shoulder: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2012; 93.

Seiji S, Takefumi F, Shigeru K. Therapeutic Effects of Hyaluronate Injections in Patients With Chronic Painful Shoulder: A Meta-Analysis of Randomized Controlled Trials. Arthritis Care Res. 2010;62:1009-18.