Intra-articular corticosteroid Injection combined with physical therapy versus physical therapy alone for adhesive capsulitis: a meta-analysis of randomized controlled trials.

Abstract

Adhesive capsulitis causes shoulder pain and limited motion. Physical therapy (PT) helps but is slow to act. This meta-analysis compares PT alone versus PT plus corticosteroid injections for pain, range of motion (ROM), and function. A systematic literature search was conducted in PubMed, Scopus, Embase, and Google Scholar for articles published up to April 24, 2026. Eligible studies were randomized controlled trials comparing PT alone to PT combined with intra-articular corticosteroid injections in adults with adhesive capsulitis. Five studies met the inclusion criteria, including 198 patients, with a follow-up duration ranging from 6 to 24 weeks. Primary outcomes included changes in SPADI (Shoulder Pain and Disability Index) and VAS (Visual Analogue Scale) scores from baseline to final follow-up, as well as ROM improvements in flexion, abduction, external rotation, and internal rotation. Patients receiving combined corticosteroid injection and PT were associated with significantly greater improvements in SPADI scores (MD = 17.52; 95% CI: 5.08 to 29.95; p = 0.006), flexion (MD = 12.99; 95% CI: 5.92 to 20.05; p = 0.0003), abduction (MD = 10.68; 95% CI: 0.53 to 20.84; p = 0.04), and external rotation (MD = 10.35; 95% CI: 6.13 to 14.57; p < 0.0001) compared to PT alone. No significant differences were observed in VAS score reduction (p = 0.41) or internal rotation (p = 0.46). The addition of intra-articular corticosteroid injections to PT provides superior short-term improvements in functional outcomes and ROM for patients with adhesive capsulitis. These results support a combined treatment approach during the early phases of the disease.