Effectiveness of surgical and non-surgical interventions for managing diabetic shoulder pain: a systematic review

© 2020 Informa UK Limited, trading as Taylor & Francis Group. Purpose: This systematic review evaluated and compared the effectiveness of non-surgical and surgical interventions for managing shoulder pain in patients with diabetes. Methods: PubMed, Scopus, CINAHL, EMBASE, Sport Discus, and Cochrane library were searched for studies published in the last 20 years. Randomized clinical trials (RCTs) and cohort studies that assessed shoulder pain in patients with diabetes and implemented one or a combination of non-surgical and surgical interventions were eligible for inclusion. The quality of the included studies was assessed using the Structured Effectiveness Quality Evaluation Scale (SEQES) tool. Data extracted from the eligible studies included study design, patient characteristics, duration of symptoms, type of interventions, outcome measures used to assess pain, follow-up intervals, and research findings. Results: A narrative synthesis with effect sizes (ES) or between-group differences was conducted. A total of 25 (14 non-surgical and 11 surgical) studies met the inclusion criteria. Six studies addressed physiotherapeutic interventions (three RCTs and three cohorts–ES = 0.07–1.3), three studies assessed the effect of steroid injections (two RCTs and one cohort–ES = 0.2–0.4), two cohorts addressed arthrographic capsular distension (between-group difference of 1.1 on Visual Analogue Scale), two cohorts addressed MUA, and one RCT addressed suprascapular nerve block (ES = 1–6). For the surgical studies, six cohorts addressed arthroscopic capsular release (ES = 0.2), three cohorts addressed arthroscopic rotator cuff repair (ES = 0.05–0.5), and one cohort addressed arthroplasty (ES = 0.3). Conclusion: Moderate- to very-low-quality evidence suggests large effects of physiotherapy modalities plus exercise and suprascapular nerve block, and trivial to small effects for surgical interventions for improving shoulder pain in patients with diabetes. Future well-designed studies are needed to provide accurate estimates of the true effects of these interventions on improving shoulder pain in patients with diabetes.Implications For Rehabilitation Shoulder pain may lead to disability in patients with diabetes. We recommend the use of physiotherapy interventions to reduce shoulder pain. Corticosteroid injections are recommended for short-term shoulder pain relief

Conservative versus surgical interventions for shoulder impingement: An overview of systematic reviews of randomized controlled trials

© 2020, University of Toronto Press Inc. All rights reserved. Purpose: Numerous systematic reviews (SRs) of randomized controlled trials (RCTs) have emerged that investigate the effectiveness of conservative (super-vised exercises) versus surgical (arthroscopic subacromial decompression) interventions for patients with shoulder impingement; however, there are dispa-rities in the quality of the evidence synthesized. The purpose of this study was to conduct an overview of SRs of RCTs to critically appraise the evidence and establish the current state of effectiveness of conservative versus surgical interventions on clinical outcomes among patients with shoulder impinge-ment. Method: The MEDLINE, EMBASE, CINAHL, and PubMed electronic databases were searched for January 2008 to September 2018, and we found SRs of RCTs of patients with shoulder impingement, subacromial pain syndrome, or subacromial impingement syndrome who had received conservative versus surgical interventions to improve outcomes. Two authors extracted the data, and two independent review authors assessed the risk of bias and qual-ity. Results: A total of 15 SRs were identified. One was rated as high quality, 7 as moderate quality, 5 as low quality, and 2 as critically low quality. The results were in line with one another, indicating that no differences in outcomes existed between conservative and surgical interventions among patients with shoulder impingement. Conclusion: There were no clinically important or statistically significant differences in outcomes between conservative versus surgical interventions among patients with subacromial impingement syndrome. To enhance clinical outcomes in this patient population, shoulder-specific exercises that aim to improve muscle strength and flexibility must be considered as the first line of conservative treatment