Interventions for adhesive capsulitis: systematic review and network meta-analysis of randomised controlled trials.
Jiahao Meng, Pan Liu, Nuno Sampaio Gomes et al.
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In 30 seconds
This systematic review and network meta-analysis compared treatments for adhesive capsulitis in adults, including 189 randomised controlled trials with 12 988 participants and 59 interventions. At short-term follow-up, moderate certainty evidence indicated that extracorporeal shockwave therapy probably reduced pain versus usual care by -1.97 on a 0-10 scale (95% confidence interval -2.97 to -0.97). Manipulation under anaesthesia, with or without intra-articular steroid injections, probably improved flexion. Most other treatment estimates were uncertain, and comparative safety was poorly established.
Key findings
- Extracorporeal shockwave therapy probably reduced short-term pain versus usual care: mean difference -1.97 on a 0-10 scale (95% confidence interval -2.97 to -0.97).
- Manipulation under anaesthesia with intra-articular steroid injections probably improved short-term flexion by 33.29° (95% confidence interval 11.19° to 55.39°).
- Manipulation under anaesthesia alone probably improved short-term flexion by 26.16° (95% confidence interval 8.19° to 44.13°).
- Most trials contributing to principal outcomes were at high risk of bias; adverse events were incompletely and inconsistently reported.
Why it matters
The review brings together a large randomised evidence base but finds that confidence in most comparisons remains limited. Its outcome-specific short-term signals may help frame discussions of potential benefits, while the uncertainty around longer-term effects and harms cautions against treating apparent absence of reported adverse events as proof of safety.
What to keep in mind
Most trials contributing to principal outcomes were at high risk of bias. Many estimates had low or very low certainty, some comparisons showed important incoherence, and adverse events were inconsistently reported. Evidence was mainly short term, with uncertain applicability beyond predominantly primary adhesive capsulitis.