| Methods |
Randomised controlled trial
Blinding: patients unable to be blinded but outcome assessors were blinded
Loss to follow‐up: Synovial group: 19(59%) of manipulation group, 18(51%) of physio group, 7(15%) of steroid injection group
Appropriate statistical analysis: yes, intention to treat. |
| Participants |
114 patients. Inclusion criteria:
Shoulder complaints defined as pain localised in region of deltoid muscle, acromioclavicular joint, superior part of trapezoid muscle and scapula). Radiation of pain in the arm could be present, and, besides the pain, the range of movement of the upper arm or shoulder girdle could be limited. Exclusion criteria included: treatment for shoulder
complaint in prior 6 months, bilateral shoulder complaints, presence of specific rheumatic disorders (polymyalgia rheumatica, rheumatoid arthritis systemic lupus erythematosus & fibromyalgia), acute severe trauma such as fracture, dislocation, cuff rupture, and herniated cervical disc.
There were 3 diagnostic groups (synovial, shoulder girdle and combination). Only the synoivial group is considered in this review.
The synovial group consisted of 114 patients with pain or limited movement in one or several directions of the glenohumeral joint. These complaints origniated from disorders of the subacromial structures, the acromioclavicular joint, the glenohumeral joint, or combinations of these (the synovial structures). |
| Interventions |
First week: All received 50 mg diclofenac sodium three times daily.
Then on the basis of reassessment they were divided into diagnostic groups.
Within the synovial group, patients were allocated to
group A (47 patients): corticosteroid injection (1‐3 injections as needed at baseline, 1 week and after 2 weeks, of 1 ml of 40 mg/ml triamcinolone acetonide with 9 ml of 10 mg/ml lignocaine) into 2 out of 3 synovial structires (glenohumeral joint capsule, subacromial space, and acromioclavicular joint;
Group B (32 patients): manipulation and mobilisation of cervical spine, upper thoracic spine, upper ribs, acromioclavicular joint, glenohumeral joint once weekly with a maximum of 6 treatments); Group C (35 patients): physiotherapy twice a week. Could use exercise therapy, massage, physical applications but no mobilisation or manipulative techniques were allowed. |
| Outcomes |
Assessment at baseline and 2, 6, 11 weeks.
1) Pain assessed by the shoulder pain score (6 item questionnaire and and 101 point numerical pain scale) (7 points = no pain to 28 =severe pain)
2) active and passive range of movement of glenohumeral joint, cervical spine, upper thoracic spine, palpating the muscle tendons on the head of humerus, the AC joint, and the upper ribs
3) felt "cured" (defined as disappearance of shoulder complaints or a decrease to such an extent that they were no longer inconvenient, did not need treatment, or no longer interfered with normal working) or if treatment failed |
| Notes |
See analyses 12, 13. |
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Allocation concealment? |
Unclear risk |
B ‐ Unclear |
