Abstract
Introduction
Shoulder pain is a common problem with an estimated prevalence of 4% to 26%. About 1% of adults aged over 45 years consult their GP with a new presentation of shoulder pain every year in the UK. The aetiology of shoulder pain is diverse and includes pathology originating from the neck, glenohumeral joint, acromioclavicular joint, rotator cuff, and other soft tissues around the shoulder girdle. The most common source of shoulder pain is the rotator cuff, accounting for over two-thirds of cases.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral drug treatment, topical drug treatment, local injections, non-drug treatment, and surgical treatment? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results
We found 71 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions
In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, arthroscopic subacromial decompression, autologous whole blood injection, corticosteroids (oral, subacromial injection, or intra-articular injection), electrical stimulation, excision of distal clavicle, extracorporeal shock wave therapy, ice, laser treatment, manipulation under anaesthesia, suprascapular nerve block, non-steroidal anti-inflammatory drugs (oral, topical or intra-articular injection), opioid analgesics, paracetamol, physiotherapy (manual treatment, exercises), platelet-rich plasma injection, rotator cuff repair, shoulder arthroplasty, and ultrasound.
Key Points
Shoulder pain encompasses a diverse array of pathologies and can affect as many as one quarter of the population depending on age and risk factors.
Shoulder pain may be due to problems with the neck, glenohumeral joint, acromioclavicular joint, rotator cuff, or other soft tissues around the shoulder.
Rotator cuff problems are the most common source of shoulder pain, accounting for more than two-thirds of cases.
Rotator cuff disorders are associated with musculoskeletal problems that affect the joints and muscles of the shoulder, cuff degeneration due to ageing and ischaemia, and overloading of the shoulder.
Frozen shoulder (adhesive capsulitis) accounts for 2% of cases of shoulder pain.
Risk factors for frozen shoulder include female sex, older age, shoulder trauma and surgery, diabetes, and cardiovascular, cerebrovascular, and thyroid disease.
In many people, the cornerstone of treatment is achieving pain control to permit a return to normal functional use of the shoulder and encourage this with manual exercises. In people with acute post-traumatic tear, an early surgical option is warranted.
We don't know whether topical NSAIDs, oral corticosteroids, oral paracetamol, or opioid analgesics improve shoulder pain, although oral NSAIDs may be effective in the short term in people with acute tendonitis/subacromial bursitis. If pain control fails, the diagnosis should be reviewed and other interventions considered.
Physiotherapy may improve pain and function in people with mixed shoulder disorders compared with placebo.
Intra-articular corticosteroid injections may reduce pain in the short term compared with physiotherapy and placebo for people with frozen shoulder, but their benefit in the long term and when compared with local anaesthetic is unclear.
Platelet-rich plasma injections may improve the speed of recovery in terms of pain and function in people having open subacromial decompression for rotator cuff impingement, but further evidence is needed.
Acupuncture may not improve pain or function in people with rotator cuff impingement compared with placebo or ultrasound.
Extracorporeal shock wave therapy may improve pain in calcific tendonitis.
We found some evidence that suprascapular nerve block, laser treatment, and arthroscopic subacromial decompression may be effective in some people with shoulder pain.
We don't know whether autologous blood injections, intra-articular NSAID injections, subacromial corticosteroid injections, electrical stimulation, ice, ultrasound, rotator cuff repair, manipulation under anaesthesia, or shoulder arthroplasty are effective as we found insufficient evidence on their effects.
About this condition
Definition
Shoulder pain arises in or around the shoulder from its joints and surrounding soft tissues. Joints include the glenohumeral, acromioclavicular, and sternoclavicular joints. Bursae and motion planes include the subacromial bursa and scapulothoracic plane. Regardless of the disorder, pain is the most common reason for consulting a practitioner. In frozen shoulder (adhesive capsulitis), pain is associated with pronounced restriction of movement. Rotator cuff disorders may affect one or more portions of the rotator cuff and can be further defined as subacromial impingement (rotator cuff tendonitis), rotator cuff tear (partial/full thickness), or calcific tendonitis. A subacromial/subdeltoid bursitis may be associated with any of these disorders, or may occur in isolation. Post-stroke shoulder pain and pain referred from the cervical spine are not addressed in this review. When selecting treatment options for shoulder pain a diagnosis of the specific pathology is rarely necessary. The most useful aspect of diagnosis is to define the source of pain as originating from the cervical spine, glenohumeral joint, rotator cuff, or acromioclavicular joint. A simple algorithm incorporating identification of red flag symptoms and signs, questions in the history, and simple shoulder tests can be followed to locate the source of the shoulder pain.
Incidence/ Prevalence
Each year in primary care in the UK, about 1% of adults aged over 45 years present with a new episode of shoulder pain. Prevalence is uncertain, with estimates from 4% to 26%. One community survey (392 people) in the UK found a 1-month prevalence of shoulder pain of 34%. A second survey (644 people aged at least 70 years), in a community-based rheumatology clinic in the UK, reported a point prevalence of 21%, with a higher frequency in women than men (25% in women v 17% in men). Seventy percent of cases involved the rotator cuff. Further analysis of 134 people included in the survey found that 65% of cases were rotator cuff lesions, 11% were caused by localised tenderness in the pericapsular musculature, 10% involved acromioclavicular joint pain, 3% involved glenohumeral joint arthritis, and 5% were referred pain from the neck. Another survey in Sweden found that, in adults, the annual incidence of frozen shoulder was about 2%, with those aged 40 to 70 years most commonly affected.
Aetiology/ Risk factors
Rotator cuff disorders are associated with excessive overloading, instability of the glenohumeral and acromioclavicular joints, muscle imbalance, adverse anatomical features (narrow coracoacromial arch and a hooked acromion), rotator cuff degeneration with ageing, ischaemia, and musculoskeletal diseases that result in wasting of the cuff muscles. Risk factors for frozen shoulder (adhesive capsulitis) include female sex, older age, shoulder trauma, surgery, diabetes, cardiorespiratory disorders, cerebrovascular events, thyroid disease, and hemiplegia. Arthritis of the glenohumeral joint can occur in numerous forms, including primary and secondary osteoarthritis, rheumatoid arthritis, and crystal arthritides. Shoulder pain can also be referred from other sites, in particular the cervical spine. It can also arise after stroke. Post-stroke shoulder pain and referred pain are not addressed in this review.
Prognosis
One survey in community of older people found that most people with shoulder pain were still affected 3 years after the initial survey. One prospective cohort study of 122 adults in primary care found that 25% of people with shoulder pain reported previous episodes and 49% reported full recovery at 18 months' follow-up.
Aims of intervention
To reduce pain and to improve range of movement and function, with minimal adverse effects.
Outcomes
Symptom improvement: pain scores (overall score, on activity, at night, at rest, during the day, analgesia count); range of movement measures; assessment of overall severity (self assessed or by blinded assessor); functional score; global improvement scores (self-assessed or by blinded assessor); tenderness; strength; stiffness. Adverse effects of treatment. There is an array of validated patient-reported outcome measures specific to assessment of the shoulder; commonly used questionnaires include the Constant–Murley shoulder score, the Oxford Shoulder Score, and the Shoulder Pain and Disability Index. Many of the validated measures include different elements; for example, pain and disability, in an overall score.
Methods
Clinical Evidence search and appraisal August 2009. The following databases were used to identify studies for this systematic review: Medline 1966 to August 2009, Embase 1980 to August 2009, and The Cochrane Database of Systematic Reviews 2009, Issue 3 (1966 to date of issue). An additional search within The Cochrane Library was carried out for the Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment (HTA). We also searched for retractions of studies included in the review. Abstracts of the studies retrieved from the initial search were assessed by an information specialist. Selected studies were then sent to the contributor for additional assessment, using pre-determined criteria to identify relevant studies. Study design criteria for inclusion in this review were: published systematic reviews of RCTs and RCTs in any language, at least single blinded, and containing more than 20 individuals of whom more than 80% were followed up. There was no minimum length of follow-up required to include studies. We excluded all studies described as "open", "open label", or not blinded unless blinding was impossible. We included systematic reviews of RCTs and RCTs where harms of an included intervention were studied applying the same study design criteria for inclusion as we did for benefits. In addition, we use a regular surveillance protocol to capture harms alerts from organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA), which are added to the reviews as required. General reporting: At this update of the review, we have revised the previous structure of the reporting of this review to separately present data in people with non-specific shoulder pain, acromioclavicular joint disease, glenohumeral joint disease, and rotator cuff disease. We compared each intervention versus placebo or no treatment and versus any other listed intervention, and reported any studies of sufficient quality that we found. To aid readability of the numerical data in our reviews, we round many percentages to the nearest whole number. Readers should be aware of this when relating percentages to summary statistics such as relative risks (RRs) and odds ratios (ORs). We have performed a GRADE evaluation of the quality of evidence for interventions included in this review (see table ). The categorisation of the quality of the evidence (into high, moderate, low, or very low) reflects the quality of evidence available for our chosen outcomes in our defined populations of interest. These categorisations are not necessarily a reflection of the overall methodological quality of any individual study, because the Clinical Evidence population and outcome of choice may represent only a small subset of the total outcomes reported, and population included, in any individual trial. For further details of how we perform the GRADE evaluation and the scoring system we use, please see our website (www.clinicalevidence.com).
Table 1.
GRADE evaluation of interventions for shoulder pain
| Important outcomes | Symptom improvement, adverse effects | ||||||||
| Number of studies (participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of oral drug treatment in people with shoulder pain? | |||||||||
| 2 (78) | Symptom improvement | Oral corticosteroids v placebo in people with glenohumeral joint disease | 4 | –2 | –1 | –1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Consistency point deducted for inconsistent results depending on time frame. Directness point deducted for no between group comparisons in 1 RCT |
| 1 (40) | Symptom improvement | Oral corticosteroids plus home exercises v home exercises alone in people with glenohumeral joint disease | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for inclusion of co-interventions (analgesics, diazepam) |
| 1 (30) | Symptom improvement | Oral corticosteroids plus MUA plus intra-articular injection of corticosteroid v MUA plus intra-articular injection of corticosteroid alone in people with glenohumeral joint disease | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for unclear subjective outcome (dramatic response to treatment) |
| 1 (28) | Symptom improvement | Oral corticosteroids plus physiotherapy v intra-articular injection of corticosteroids plus physiotherapy in people with glenohumeral joint disease | 4 | –2 | 0 | –2 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness points deducted for co-interventions (ice and hot packs) and short-term follow-up (3 weeks) |
| 4 (463) | Symptom improvement | Oral NSAIDs v placebo in people with rotator cuff disease | 4 | –1 | 0 | –2 | 0 | Very low | Quality point deducted for incomplete reporting of results. Directness points deducted for use of subjective outcome in 1 RCT and short follow-up (4 weeks) |
| What are the effects of local injections in people with shoulder pain? | |||||||||
| 3 (167) | Symptom improvement | Suprascapular nerve block v placebo in people with glenohumeral disease | 4 | –3 | 0 | –2 | 0 | Very low | Quality points deducted for sparse data, incomplete reporting of results, and no intention-to-treat analysis/poor follow-up in 1 RCT. Directness points deducted for unclear generalisability in 1 RCT and use of composite outcome |
| 2 (173) | Symptom improvement | Intra-articular corticosteroid injection v placebo in people with glenohumeral joint disease | 4 | –2 | 0 | –2 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness points deducted for composite outcome in 1 RCT and inclusion of co-intervention (physiotherapy) in analysis |
| 1 (48) | Symptom improvement | Intra-articular corticosteroid injection plus lidocaine v lidocaine in people with glenohumeral joint disease | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for small number of comparators |
| 2 (fewer than 200) | Symptom improvement | Intra-articular corticosteroid injection v physiotherapy in people with glenohumeral joint disease | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted for use of subjective/composite outcomes |
| 1 (53) | Symptom improvement | Intra-articular corticosteroid injection plus physiotherapy v manipulation under anaesthesia plus physiotherapy in people with glenohumeral joint disease | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted for use of composite outcome |
| 1 (24) | Symptom improvement | Intra-articular corticosteroid injection plus lidocaine v placebo in people with rotator cuff disease | 4 | –2 | 0 | –2 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted for unclear outcome (treatment success) and short follow-up (4 weeks) |
| 1 (207) | Symptom improvement | Subacromial corticosteroid injection plus lidocaine v physiotherapy in people with non-specific shoulder pain | 4 | 0 | 0 | –2 | 0 | Low | Quality point deducted for incomplete reporting of results. Directness point deducted for use of composite outcome (repeat consultation or other intervention) |
| 5 (254) | Symptom improvement | Subacromial corticosteroid injections plus lidocaine v lidocaine in people with rotator cuff disease | 4 | –1 | –1 | –1 | 0 | Very low | Quality point deducted for incomplete reporting of results. Consistency point deducted for conflicting results. Directness point deducted for use of composite outcomes |
| 1 (98) | Symptom improvement | Subacromial corticosteroid injections plus bupivacaine v bupivacaine in people with rotator cuff disease | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for small number of comparators |
| 1 (40) | Symptom improvement | Open subacromial decompression plus platelet-rich plasma injection v open subacromial decompression alone in people with rotator cuff disease | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for small number of comparators |
| What are the effects of non-drug treatment in people with shoulder pain? | |||||||||
| 4 (361) | Symptom improvement | ESWT v placebo in people with rotator cuff disease (calcific tendonitis) | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for poor follow-up and no intention-to-treat analysis in 1 RCT. Directness point deducted for use of composite outcomes |
| 2 (112) | Symptom improvement | ESWT v sham treatment in people with rotator cuff disease (non-calcific rotator cuff tendinopathy) | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted for small number of comparators |
| 1 (63) | Symptom improvement | Laser treatment v placebo in people with glenohumeral joint disease | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 4 (170) | Symptom improvement | Laser treatment v placebo in people with rotator cuff disease | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for unclear outcome (recovery rates) |
| 1 (70) | Symptom improvement | Laser treatment v ultrasound in people with rotator cuff disease | 4 | –1 | 0 | –2 | 0 | Very low | Quality point deducted for sparse data. Directness points deducted for composite outcomes and short follow-up (2 weeks) |
| 1 (66) | Symptom improvement | Physiotherapy v no treatment in people with non-specific shoulder pain | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for short follow-up |
| 2 (122) | Symptom improvement | Physiotherapy v placebo or no treatment in people with glenohumeral disease | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, incomplete reporting of results, and indirect statistical analysis between groups in 1 RCT |
| 2 (185) | Symptom improvement | Physiotherapy v placebo or no treatment in people with rotator cuff disease | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for use of composite outcomes |
| 1 (180) | Symptom improvement | Electrical stimulation v sham electrical stimulation in people with non-specific shoulder pain | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and no intention-to-treat analysis. Directness point deducted for unclear outcome (large improvement) |
| 2 (89) | Symptom improvement | Electrical stimulation v sham electrical stimulation in people with rotator cuff disease | 4 | –2 | 0 | –2 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting. Directness points deducted for unclear outcome and small number of comparators |
| 1 (42) | Symptom improvement | Ice v other treatments or no treatment in people with glenohumeral joint disease | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted for small number of comparators |
| 2 (unclear, fewer than 200) | Symptom improvement | Ultrasound v placebo or no treatment in people with non-specific shoulder pain | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted for unclear subjective outcome (very large improvement) |
| 1 (49) | Symptom improvement | Ultrasound plus physiotherapy v placebo plus physiotherapy in people with glenohumeral disease | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for use of composite outcome |
| 3 (184) | Symptom improvement | Ultrasound v placebo or no treatment in people with rotator cuff disease | 4 | –2 | 0 | –2 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted for unclear intervention (no details of ultrasound reported) and unclear outcome (treatment success) |
| 1 (38) | Symptom improvement | Ultrasound plus physiotherapy v placebo plus physiotherapy in people with rotator cuff disease | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for short follow-up (15 days) |
| 1 (24) | Symptom improvement | Ultrasound v acupuncture in people with rotator cuff disease | 4 | –3 | 0 | 0 | 0 | Very low | Quality point deducted for sparse data, inadequate allocation concealment, and unclear intervention (no details reported of ultrasound) |
| 1 (85) | Symptom improvement | Ultrasound plus physiotherapy v acupuncture plus physiotherapy in people with rotator cuff disease | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted for use of co-interventions |
| 2 (172) | Symptom improvement | Acupuncture v placebo in people with non-specific shoulder pain | 4 | –3 | 0 | –1 | 0 | Very low | Quality point deducted for sparse data, weak methods in 1 RCT, and no intention-to-treat analysis in 1 RCT. Directness point deducted for variation of intervention in 1 RCT (positive and negative setting) |
| 1 (24) | Symptom improvement | Acupuncture v placebo in people with rotator cuff disease | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and weak methods (inadequate allocation concealment). Directness point deducted for short follow-up (4 weeks) |
| What are the effects of surgical treatment in people with shoulder pain? | |||||||||
| 1 (30) | Symptom improvement | Manipulation plus intra-articular hydrocortisone injection v intra-articular hydrocortisone injection alone in people with glenohumeral joint disease | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for small number of comparators |
| 1 (fewer than 125) | Symptom improvement | Surgical arthroscopic decompression v sham laser in people with rotator cuff disease | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for composite outcome |
| 1 (fewer than 125) | Symptom improvement | Surgical arthroscopic decompression v physiotherapy in people with rotator cuff disease | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for composite outcome |
| 2 (173) | Symptom improvement | Arthroscopic rotator cuff repair plus arthroscopic subacromial decompression v rotator cuff repair without arthroscopic subacromial decompression in people with rotator cuff disease | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for use of composite outcome |
Type of evidence: 4 = RCT. ESWT, Extracorporeal shock wave treatment; MUA, manipulation under anaesthesiaConsistency: similarity of results across studies Directness: generalisability of population or outcomes Effect size: based on relative risk or odds ratio
Glossary
- Interferential electrical stimulation
Typically, a high-frequency current (4000 Hz) amplitude modulated at a lower frequency (60–100 Hz) given in bursts of 4 seconds and repeated for up to 15 minutes.
- Low-quality evidence
Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
- Maitland mobilisation
A graded system of manipulations and exercises intended to increase mobility of specific joints.
- Neer score
Assesses pain during the past week, clinical testing of shoulder function, active range of movement, and anatomical or radiological examination. Scores range from 0 to 100 points.
- Shoulder pain and disability index (SPADI)
A self administered instrument for measuring pain (5 items) and disability (8 items).
- Very low-quality evidence
Any estimate of effect is very uncertain.
Disclaimer
The information contained in this publication is intended for medical professionals. Categories presented in Clinical Evidence indicate a judgement about the strength of the evidence available to our contributors prior to publication and the relevant importance of benefit and harms. We rely on our contributors to confirm the accuracy of the information presented and to adhere to describe accepted practices. Readers should be aware that professionals in the field may have different opinions. Because of this and regular advances in medical research we strongly recommend that readers' independently verify specified treatments and drugs including manufacturers' guidance. Also, the categories do not indicate whether a particular treatment is generally appropriate or whether it is suitable for a particular individual. Ultimately it is the readers' responsibility to make their own professional judgements, so to appropriately advise and treat their patients. To the fullest extent permitted by law, BMJ Publishing Group Limited and its editors are not responsible for any losses, injury or damage caused to any person or property (including under contract, by negligence, products liability or otherwise) whether they be direct or indirect, special, incidental or consequential, resulting from the application of the information in this publication.
Contributor Information
Richard J Murphy, University of Oxford, Oxford, UK.
Andrew J Carr, University of Oxford, Oxford, UK.
References
- 1.Mitchell C, Adebajo A, Hay E, et al. Shoulder pain: diagnosis and management in primary care. BMJ 2005;331:1124–1128. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Royal College of General Practitioners; Office of Populations, Censuses and Surveys. Third national morbidity survey in general practice, 1980–1981; Department of Health and Social Security, series MB5 No 1. London: HMSO. [Google Scholar]
- 3.Bergunnud H, Lindgarde F, Nilsson B, et al. Shoulder pain in middle age. Clin Orthop 1988;231:234–238. [PubMed] [Google Scholar]
- 4.McCormack RR, Inman RD, Wells A, et al. Prevalence of tendinitis and related disorders of the upper extremity in a manufacturing workforce. J Rheumatol 1990;17:958–964. [PubMed] [Google Scholar]
- 5.Allander E. Prevalence, incidence and remission rates of some common rheumatic diseases or syndromes. Scand J Rheumatol 1974;3:145–153. [DOI] [PubMed] [Google Scholar]
- 6.Badley EM, Tennant A. Changing profile of joint disorders with age: findings from a postal survey of the population of Calderdale, West Yorkshire, UK. Ann Rheum Dis 1992;51:366–371. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Andersson HI, Ejlertsson G, Leden I, et al. Chronic pain in a geographically defined general population: studies of differences in age, gender, social class and pain localisation. Clin J Pain 1993;9:174–182. [DOI] [PubMed] [Google Scholar]
- 8.Urwin M, Symmons D, Allison T, et al. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis 1998;57:649–655. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Pope DP, Croft PR, Pritchard CM, et al. The frequency of restricted range of movement in individuals with self-reported shoulder pain: results from a population-based survey. Br J Rheumatol 1996:35;1137–1141. [DOI] [PubMed] [Google Scholar]
- 10.Chard M, Hazleman R, Hazleman BL, et al. Shoulder disorders in the elderly: a community survey. Arthritis Rheum 1991;34:766–769. [DOI] [PubMed] [Google Scholar]
- 11.Vecchio-P, Kavanagh R, Hazleman BL, et al. Shoulder pain in a community-based rheumatology clinic. Br J Rheumatol 1995;34:440–442. [DOI] [PubMed] [Google Scholar]
- 12.Lundberg B. The frozen shoulder. Acta Orthop Scand 1969;119:1–59. [PubMed] [Google Scholar]
- 13.Riordan J, Dieppe PA. Arthritis of the glenohumeral joint. Baillieres Clin Rheumatol 1989;3:607–626. [DOI] [PubMed] [Google Scholar]
- 14.Bonutti PM, Hawkins RJ. Rotator cuff disorders. Baillieres Clin Rheumatol 1989;3:535–550. [DOI] [PubMed] [Google Scholar]
- 15.Jobe FW, Kvitne RS. Shoulder pain in the overhand or throwing athlete: the relationship of anterior instability and rotator cuff impingement. Orthop Rev 1989;18:963–975. [PubMed] [Google Scholar]
- 16.Soslowsky LJ, An CH, Johnston SP, et al. Geometric and mechanical properties of the coracoacromial ligament and their relationship to rotator cuff disease. Clin Orthop 1994;304:10–17. [PubMed] [Google Scholar]
- 17.Nash P, Hazleman BL. Frozen shoulder. Baillieres Clin Rheumatol 1989;3:551–566. [DOI] [PubMed] [Google Scholar]
- 18.Wohlgethan JR. Frozen shoulder in hyperthyroidism. Arthritis Rheum 1987;30:936–939. [DOI] [PubMed] [Google Scholar]
- 19.Vecchio PC, Kavanagh RT, Hazleman BL, et al. Community survey of shoulder disorders in the elderly to assess the natural history and effects of treatment. Ann Rheumatol Dis 1995;54:152–154. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Croft P, Pope D, Silman A. The clinical course of shoulder pain: prospective cohort study in primary care. BMJ 1996;313:601–602. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Roach KE, Budiman-Mak E, Songsiridej N, et al. Development of a shoulder pain and disability index. Arthritis Care Res 1991;4:143–149. [PubMed] [Google Scholar]
- 22.Croft P, Pope D, Zonca M, et al. Measurement of shoulder related disability: results of a validation study. Ann Rheum Dis 1994;53:525–528. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Beaton DE, Richards RR. Measuring function of the shoulder. A cross-sectional comparison of five questionnaires. J Bone Joint Surg Am 1996;78;882–890. [DOI] [PubMed] [Google Scholar]
- 24.Gerber C. Integrated scoring systems for the functional assessment of the shoulder. In: Matsen III FA, Fu EH, Hawkins RJ, eds. The shoulder: a balance of mobility and stability. Rosemont, IL, USA: The American Academy of Orthopaedic Surgeons, 1993:531–550. [Google Scholar]
- 25.Richards RR, An KN, Bigliani LU, et al. A standardised method for the assessment of shoulder function. J Shoulder Elbow Surg 1994;3:347–352. [DOI] [PubMed] [Google Scholar]
- 26.L'Insalata JC, Warren RF, Cohen SF, et al. A self-administered questionnaire for assessment of symptoms and function of the shoulder. J Bone Joint Surg 1997;79:738–748. [PubMed] [Google Scholar]
- 27.Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Rel Res 1987;1:160–164. [PubMed] [Google Scholar]
- 28.Dawson J, Fitzpatrick R, Carr A, et al. Questionnaire on the perceptions of patients about shoulder surgery. J Bone Joint Surg Br 1996;78:593–600. [PubMed] [Google Scholar]
- 29.Buchbinder R, Green S, Youd JM, et al. Oral steroids for adhesive capsulitis. In: The Cochrane Library, Issue 3, 2009. Chichester, UK: John Wiley & Sons, Ltd. Search date 2005. [Google Scholar]
- 30.Blockey NJ, Wright JK, Kellgren JH. Oral cortisone therapy in periarthritis of the shoulder. BMJ 1954;i:1455–1457. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Buchbinder R, Hoving JL, Green S, et al. Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial. Ann Rheum Dis 2004;63:1460–1469. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Binder A, Hazleman BL, Parr G, et al. A controlled study of oral prednisolone in frozen shoulder. Br J Rheumatol 1986;25:288–292. [DOI] [PubMed] [Google Scholar]
- 33.Kessel L, Bayley I, Young A. The upper limb. The frozen shoulder. Br J Hosp Med 1981;25:334–338. [PubMed] [Google Scholar]
- 34.Widiastuti-Samekto M, Sianturi GP. Frozen shoulder syndrome: comparison of oral route corticosteroid and intra-articular corticosteroid injection. Med J Malaysia 2004;59:312–316. [PubMed] [Google Scholar]
- 35.Green S, Buchbinder R, Glazier R, et al. Interventions for shoulder pain. In: The Cochrane Library, Issue 1, 2006 [Withdrawn]. Chichester, UK: John Wiley & Sons, Ltd. Search date 1998. [Google Scholar]
- 36.Mena HR, Lomen PL, Turner LF, et al. Treatment of acute shoulder syndrome with flurbiprofen. Am J Med 1986;80:141–144. [DOI] [PubMed] [Google Scholar]
- 37.Petri M, Hufman SL, Waser G, et al. Celecoxib effectively treats patients with acute shoulder tendinitis/bursitis. J Rheumatol 2004;31:1614–1620. [PubMed] [Google Scholar]
- 38.Adejabo AO, Nash P, Hazleman BL. A prospective blind dummy placebo controlled study comparing triamcinolone hexacetonide injection with oral diclofenac 50 mg tds in patients with rotator cuff tendinitis. J Rheumatol 1990;17:1207–1210. [PubMed] [Google Scholar]
- 39.Petri M, Dobrow R, Neiman R, et al. Randomised double blind, placebo controlled study of the treatment of the painful shoulder. Arthritis Rheum 1987;30:1040–1045. [DOI] [PubMed] [Google Scholar]
- 40.Shanahan EM, Ahern M, Smith M, et al. Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. Ann Rheum Dis 2003;62:400–406. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41.Neal JM, McDonald SB, Larkin KL, et al. Suprascapular nerve block prolongs analgesia after nonarthroscopic shoulder surgery but does not improve outcome. Anesth Analg 2003;96:982–986. [DOI] [PubMed] [Google Scholar]
- 42.Dahan TH, Fortin L, Pelletier M, et al. Double blind randomized clinical trial examining the efficacy of bupivacaine suprascapular nerve blocks in frozen shoulder. J Rheumatol 2000;27:1464–1469. [PubMed] [Google Scholar]
- 43.Carette S, Moffet H, Tardif J, et al. Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial. Arthritis Rheum 2003;48:829–838. [DOI] [PubMed] [Google Scholar]
- 44.Ryans I, Montgomery A, Galway R, et al. A randomized controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis. Rheumatology 2005;44:529–535. [DOI] [PubMed] [Google Scholar]
- 45.Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. In: The Cochrane Library, Issue 3, 2009. Chichester, UK: John Wiley & Sons, Ltd. Search date 2002. [Google Scholar]
- 46.Rizk T, Pinals R, Talaiver A. Corticosteroid injections in adhesive capsulitis: investigation of their value and site. Arch Phys Med 1991;72:20–22. [PubMed] [Google Scholar]
- 47.Van der Windt DA, Koes BW, Deville W, et al. Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care: randomised trial. BMJ 1998;317:1292–1296. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 48.Jacobs LG, Smith MG, Khan SA, et al. Manipulation or intra-articular steroids in the management of adhesive capsulitis of the shoulder? A prospective randomized trial. J Shoulder Elbow Surg 2009;18:348–353. [DOI] [PubMed] [Google Scholar]
- 49.Gray RG, Gottlieb NL. Intra-articular corticosteroids. An updated assessment. Clin Orth 1983;177:235–263. [PubMed] [Google Scholar]
- 50.Hollander JL. The use of intra-articular hydrocortisone, its analogues, and its higher esters in arthritis. Md Med J 1970;61:511. [DOI] [PubMed] [Google Scholar]
- 51.Eustace JA, Brophy DP, Gibney RP, et al. Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms. Ann Rheum Dis 1997;56:59–63. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 52.Jones A, Regan M, Ledingham J, et al. Importance of placement of intra-articular steroid injections. BMJ 1993;307:1329–1330. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 53.De Jong BA, Dahmen R, Hogeweg JA, et al. Intra-articular triamcinolone acetonide injection in patients with capsulitis of the shoulder: a comparative study of two dose regimens. Clin Rehabil 1998;12:211–215. [DOI] [PubMed] [Google Scholar]
- 54.Schellingerhout JM, Thomas S, Verhagen AP, et al. Aspecific shoulder complaints: literature review to assess the efficacy of current interventions. [In Dutch]. Ned Tijdschr Geneeskd 2007;151:2892–2897. [PubMed] [Google Scholar]
- 55.Hay EM, Thomas E, Paterson SM, et al. A pragmatic randomised controlled trial of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care. Ann Rheum Dis 2003;62:394–399. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 56.Vecchio PC, Hazleman BL, King RH. A double-blind trial comparing subacromial methylprednisolone and lignocaine in acute rotator cuff tendinitis. Br J Rheumatol 1993;32:743–745. [DOI] [PubMed] [Google Scholar]
- 57.Kirkley A. Prospective double blind randomised clinical trial of subacromial injection of betamethasone and xylocaine versus xylocaine alone in rotator cuff tendinosis. J Bone Joint Surg Br 1999;81:107. [DOI] [PubMed] [Google Scholar]
- 58.Blair B, Rokito AS, Cuomo F, et al. Efficacy of injections of corticosteroids for subacromial impingement syndrome. J Bone Joint Surg Am 1996;78:1685–1689. [DOI] [PubMed] [Google Scholar]
- 59.Alvarez-Nemegyei J, Bassol-Perea, Pasos JR. Efficacy of the local injection of methylprednisolone acetate in the subacromial impingement syndrome. A randomized, double-blind trial. Reumatol Clin 2008;4:49–54. [DOI] [PubMed] [Google Scholar]
- 60.McInerney JJ, Dias J, Durham S, et al. Randomised controlled trial of single, subacromial injection of methylprednisolone in patients with persistent, post-traumatic impingement of the shoulder. Emerg Med J 2003;20:218–221. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 61.Ekeberg OM, Bautz-Holter E, Tveita EK, et al. Subacromial ultrasound guided or systemic steroid injection for rotator cuff disease: randomised double blind study. BMJ 2009;338:273–275. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 62.Everts PA, Devilee RJ, Brown Mahoney C, et al. Exogenous application of platelet-leukocyte gel during open subacromial decompression contributes to improved patient outcome. A prospective randomized double-blind study. Eur Surg Res 2008;40:203–210. [DOI] [PubMed] [Google Scholar]
- 63.Loew M, Daecke W, Kusnierczak D, et al. Shock-wave therapy is effective for chronic calcifying tendinitis of the shoulder. J Bone Joint Surg Br 1999;81:863–867. [DOI] [PubMed] [Google Scholar]
- 64.Gerdesmeyer L, Wagenpfeil S, Haake M, et al. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial. JAMA 2003;290:2573–2580. [DOI] [PubMed] [Google Scholar]
- 65.Peters J, Luboldt W, Schwarz W, et al. Extracorporeal shock wave therapy in calcific tendinitis of the shoulder. Skeletal Radiol 2004;33:712–718. [DOI] [PubMed] [Google Scholar]
- 66.Hsu CJ, Wang DY, Tseng KF, et al. Extracorporeal shock wave therapy for calcifying tendinitis of the shoulder. J Shoulder Elbow Surg 2008;17:55–59. [DOI] [PubMed] [Google Scholar]
- 67.Speed CA, Richards C, Nichols D, et al. Extracorporeal shock-wave therapy for tendinitis of the rotator cuff. A double-blind, randomised, controlled trial. J Bone Joint Surg 2002;84:509–512. [DOI] [PubMed] [Google Scholar]
- 68.Schmitt J, Haake M, Tosche A, et al. Low-energy extracorporeal shock-wave treatment for tendinitis of the supraspinatus. J Bone Joint Surg 2001;83:873–876. [DOI] [PubMed] [Google Scholar]
- 69.Stergioulas A. Low-power laser treatment in patients with frozen shoulder: preliminary results. Photomed Laser Surg 2008/4;26:99–105. [DOI] [PubMed] [Google Scholar]
- 70.Green S, Buchbinder R, Hetrick S. Physiotherapy interventions for shoulder pain. In: The Cochrane Library, Issue 3, 2009. Chichester, UK: John Wiley & Sons, Ltd. Search date 2002. [Google Scholar]
- 71.Gudmundssen J, Vikne J. Laser treatment for epicondylitis humeri and rotator cuff syndrome. Nord Tidskr Idrettsmed 1987;2:6–15. [Google Scholar]
- 72.Vecchio P, Cave C, King V, et al. A double blind study of the effectiveness of low level laser treatment of rotator cuff tendinitis. Br J Rheumatol 1993;32:740–742. [DOI] [PubMed] [Google Scholar]
- 73.England S, Farrell A, Coppock J, et al. Low laser therapy of shoulder tendinitis. Scand J Rheumatol 1989;18:427–443. [DOI] [PubMed] [Google Scholar]
- 74.Saunders L. The efficacy of low level laser therapy in supraspinatus tendinitis. Clin Rehabil 1995;9:126–134. [Google Scholar]
- 75.Taverna E, Parrini M, Cabitza P. Laser therapy in the treatment of some bone and joint pathology. [In Italian] Minerva Ortop Traumatol 1990;41:631–636. [Google Scholar]
- 76.Santamato A, Solfrizzi V, Panza F, et al. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of people with subacromial impingement syndrome: a randomized clinical trial. Phys Ther 2009;89:643–652. [DOI] [PubMed] [Google Scholar]
- 77.Ginn KA, Herbert RD, Khouw W, et al. A randomized, controlled trial of a treatment for shoulder pain. Phys Ther 1997;77:802–811. [DOI] [PubMed] [Google Scholar]
- 78.Bulgen D, Binder A, Hazleman B, et al. Frozen shoulder: prospective clinical study with an evaluation of three treatment regimens. Ann Rheum Dis 1984;43:353–360. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 79.Lombardi I Jr, Magri AG, Fleury AM, et al. Progressive resistance training in patients with shoulder impingement syndrome: a randomized controlled trial. Arthritis Rheum 2008;59:615–622. [DOI] [PubMed] [Google Scholar]
- 80.Brox J, Staff P, Ljunggren A, et al. Arthroscopic surgery compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome). BMJ 1993;307:899–903. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 81.Brox JI, Gjengedal E, Uppheim G, et al. Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome): a prospective, randomised, controlled study in 125 patients with a 2½ year follow-up. J Shoulder Elbow Surg 1999;8:102–111. [DOI] [PubMed] [Google Scholar]
- 82.Coghlan JA, Buchbinder R, Green S, et al. Surgery for rotator cuff disease. In: The Cochrane Library, Issue 3, 2009. Chichester, UK: John Wiley & Sons, Ltd. Search date 2006. [Google Scholar]
- 83.Dal Conte G, Rivoltini P, Combi F. Treatment of calcific periarthritis of the shoulder with pulsed electromagnetic field therapy: a controlled study. [In Italian] Riabilitazione 1990;23:27–33. [Google Scholar]
- 84.Van der Heijden GJMG, Leffers P, Wolters PJMC, et al. No effect of bipolar interferential electrotherapy and pulsed ultrasound for soft tissue shoulder disorders: a randomised controlled trial. Ann Rheum Dis 1999;58:530–540. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 85.Downing D, Weinstein A. Ultrasound therapy of subacromial bursitis. Phys Ther 1986;66:194–199. [DOI] [PubMed] [Google Scholar]
- 86.Dogru H, Basaran S, Sarpel T, et al. Effectiveness of therapeutic ultrasound in adhesive capsulitis. Joint Bone Spine 2008;75:445–450. [DOI] [PubMed] [Google Scholar]
- 87.Ebenbichler GR, Erdogmus CB, Resch KL, et al. Ultrasound therapy for calcific tendinitis of the shoulder. N Engl J Med 1999;340:1533–1588. [DOI] [PubMed] [Google Scholar]
- 88.Berry H, Fernandes L, Bloom B, et al. Clinical study comparing acupuncture, physiotherapy, injection and oral anti-inflammatory treatment in shoulder lesions. Curr Med Res Opin 1980;7:121–126. [DOI] [PubMed] [Google Scholar]
- 89.Nykanen M. Pulsed ultrasound treatment of the painful shoulder: a randomised, double-blind, placebo-controlled study. Scand J Rehabil Med 1995;27:105–108. [PubMed] [Google Scholar]
- 90.Kurtais Gursel Y, Ulus Y, Bilgic A, et al. Adding ultrasound in the management of soft tissue disorders of the shoulder: a randomized placebo-controlled trial. Phys Ther 2004;84:336–343. [PubMed] [Google Scholar]
- 91.Green S, Buchbinder R, Hetrick S, et al. Acupuncture for shoulder pain. In: The Cochrane Library, Issue 3, 2009. Chichester, UK: John Wiley & Sons, Ltd. Search date 2003. [Google Scholar]
- 92.Johansson KM, Adolfsson LE, Foldevi MO, et al. Effects of acupuncture versus ultrasound in patients with impingement syndrome: randomized clinical trial. Phys Ther 2005;85:490–501. [PubMed] [Google Scholar]
- 93.Moore ME, Berk SN. Acupuncture for chronic shoulder pain. An experimental study with attention to the role of placebo and hypnotic susceptibility. Ann Intern Med 1976;84:381–384. [DOI] [PubMed] [Google Scholar]
- 94.Guerra de Hoyos JA, Andrés Martín Mdel C, Bassas y Baena de Leon E, et al. Randomised trial of long term effect of acupuncture for shoulder pain. Pain 2004;112:289–298. [DOI] [PubMed] [Google Scholar]
- 95.Thomas D, Williams R, Smith D. The frozen shoulder. A review of manipulative treatment. Rheumatol Rehabil 1980;19:173–179. [DOI] [PubMed] [Google Scholar]
- 96.Loew M, Heichel TO, Lehner, B. Intraarticular lesions in primary frozen shoulder after manipulation under general anesthesia. J Shoulder Elbow Surg 2005;14:16–21. [DOI] [PubMed] [Google Scholar]
- 97.Hamdan TA, Al Essa KA. Manipulation under anaesthesia for the treatment of frozen shoulder. Int Orthop 2003;27:107–109. [DOI] [PubMed] [Google Scholar]
- 98.Gartsman GM, O'connor, DP. Arthroscopic rotator cuff repair with and without arthroscopic subacromial decompression: a prospective, randomized study of one-year outcomes. J Shoulder Elbow Surg 2004;13:424–426. [DOI] [PubMed] [Google Scholar]
- 99.Milano G, Grasso A, Salvatore M, et al. Arthroscopic rotator cuff repair with and without subacromial decompression: a prospective randomized study. Arthroscopy 2007;23:81–88. [DOI] [PubMed] [Google Scholar]