Comparative Efficacy of Isolated Hydrodilatation and Hydrodilatation with Adjuvant Interventions for Frozen Shoulder: A Network Meta-analysis
In brief
Hydrodilatation plus steroid injection improved frozen-shoulder abduction by 33 degrees
In a network meta-analysis of 20 randomized trials involving 1,410 people, hydrodilatation with an additional steroid injection was linked to 33 degrees greater improvement in abduction and 23 degrees in forward flexion. A different approach, steroid hydrodilatation at the rotator interval, ranked best for pain relief and external rotation; head-to-head trials are needed to confirm which works best.
- Journal
- American journal of physical medicine & rehabilitation (Q1)
- Published
- 2 November 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Qingyu Lei, Juanjuan Li, Xin Xie
- PMID
- 42968361
- DOI
- 10.1097/PHM.0000000000003197
Why clinicians should know about it
- Picked for Rehabilitation (paper of the day, 5 November 2026): Comparative treatment effectiveness for frozen shoulder and range of motion
Abstract
OBJECTIVE: This study aimed to compare hydrodilatation (HD)-based interventions for pain relief and range of motion (ROM) improvement in frozen shoulder. METHODS: PubMed, Embase, Cochrane Library, and Web of Science were searched through September 2025 for randomized controlled trials (RCTs). Outcomes included visual analogue scale (VAS) pain scores and ROM. Effect sizes were standardized mean differences (SMDs) or mean differences (MDs) with 95% credible intervals (CrIs). Interventions were ranked by the surface under the cumulative ranking curve (SUCRA). RESULTS: Twenty RCTs (n=1,410) were included. Anterior rotator interval corticosteroid hydrodilatation (ARICHD) reduced pain (SMD=-1.30, 95% CrI -1.80 to -0.78; SUCRA=97.2%), whereas anterior shoulder joint hydrodilatation (ASJHD) increased pain (SMD=0.97, 95% CrI 0.30 to 1.60). For ROM, anterior intra-articular corticosteroid hydrodilatation combined with additional intra-articular corticosteroid injection (AIACHD + IACI) improved forward flexion (MD=23, 95% CrI 12 to 33; SUCRA=97.7%) and abduction (MD=33, 95% CrI 23 to 43; SUCRA=98.8%), while ARICHD improved external rotation (MD=21, 95% CrI 14 to 28; SUCRA=97.8%). Isolated suprascapular nerve block (SSNB) may reduce internal rotation (MD=-17, 95% CrI -34 to -0.13). CONCLUSIONS: HD-based interventions differ in efficacy. ARICHD is associated with pain relief and improved external rotation, whereas AIACHD + IACI is associated with greater ROM improvement.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.