Oral steroids for adhesive capsulitis

Buchbinder R, Green S, Youd JM, Johnston RV

Summary

Oral steroids for shoulder pain (adhesive capsulitis)

This summary of a Cochrane review presents what we know from research about the effect of steroids taken as pills (oral) for adhesive capsulitis. The review shows that:

There is silver level evidence (www.cochranemsk.org) that oral steroids may work to treat shoulder pain (adhesive capsulitis) in the short term. Oral steroids may decrease pain and disability, and may improve movement in the shoulder in the short term. But the benefits of oral steroids may not last 6 weeks. Oral steroids taken for short periods in people who are otherwise healthy may not cause harms. There is not enough evidence to be certain of the benefits and harms of oral steroids and more research is needed.

What is adhesive capsulitis and what drugs are used to treat it?
Shoulder pain can be caused by a number of different conditions. It can be caused by rotator cuff disease or adhesive capsulitis (also called frozen shoulder, stiff painful shoulder or periarthritis). While both conditions are painful, adhesive capsulitis also tends to cause stiffness in the shoulder no matter which way you move it. The pain and stiffness in the shoulder can go away on its own but could last up to 2 to 3 years. Some people may still not be able to move their shoulder fully after 3 years.

Drug and non-drug treatments are used to relieve the pain and stiffness. In other arthritis diseases, steroids, taken as pills, have been shown to work. It is therefore thought that steroids, such as prednisolone or cortisone pills, may work for adhesive capsulitis.

What are the results of this review?
The studies tested people who had adhesive capsulitis for about 6 months. They were given no treatment, fake treatments, steroid injections or oral steroids. Oral steroids, such as prednisolone or cortisone were given for about 3 to 4 weeks, and sometimes again for another 3 to 4 weeks if people still had pain and stiffness. All people had physiotherapy or an exercise programme while taking the steroids.

Benefits of oral steroids
In people with adhesive capsulitis, at 3 weeks, oral steroids

may work more than fake pills

­48 out of 100 people who took fake pills said they were better
­96 out of 100 people who took steroids said they were better

may decrease pain and disability more than fake pills

­pain may decrease by 2.7 more points on a scale of 0 to 10 with steroids
­disability may decrease by 18 more points on a scale of 0 to 100 with steroids

may increase the ability to move the shoulder more than fake pills

­shoulder movement increased by 23 degrees
But these benefits did not last as long as 6 weeks so there is not enough evidence to be certain of the results beyond 3 weeks.

Oral steroids may also improve pain earlier and quicker than no treatment at all. But after 5 months there were no benefits of oral steroids over no treatment. There is also not enough evidence to be certain of the results.

Harms of oral steroids
In people with adhesive capsulitis who have no serious other problems, taking oral steroids for a short time may not cause serious side effects. But there is not enough evidence to be certain. Other research about steroids taken over longer periods of time shows that harms could include high cholesterol and high blood pressure.