Physiotherapy manual therapy is more effective than Corticosteriod injection (Cortisone shot) for the treatment of shoulder impingement syndrome. While the outcomes were similar after 1 year, the Corticosteriod injection group were using more health resources (doctor’s visits, medications, other treatments) than the Physiotherapy Group.
Rhon DI, Boyles RB, Cleland JA. One-year outcome of subacromial corticosteroid injection compared with manual physical therapy for the management of the unilateral shoulder impingement syndrome: a pragmatic randomized trial. Ann Intern Med. 2014 Aug 5;161(3):161-9. doi: 10.7326/M13-2199. (Original)

Background

Corticosteroid injections (CSIs) and physical therapy are used to treat patients with the shoulder impingement syndrome (SIS) but have never been directly compared.

OBJECTIVE:
To compare the effectiveness of 2 common nonsurgical treatments for SIS.

DESIGN:
Randomized, single-blind, comparative-effectiveness, parallel-group trial. (ClinicalTrials.gov:NCT01190891).

SETTING:
Military hospital-based outpatient clinic in the United States.

PATIENTS:
104 patients aged 18 to 65 years with unilateral SIS between June 2010 and March 2012.

INTERVENTIONS:
Random assignment into 2 groups: 40-mg triamcinolone acetonide subacromial CSIversus 6 sessions of manual physical therapy.

MEASUREMENTS:
The primary outcome was change in Shoulder Pain and Disability Index scores at 1 year. Secondary outcomes included the Global Rating of Change scores, the Numeric Pain Rating Scale scores, and 1-year health care use.

RESULTS:
Both groups demonstrated approximately 50% improvement in Shoulder Pain and Disability Index scores maintained through 1 year; however, the mean difference between groups was not significant (1.5% [95% CI, -6.3% to 9.4%]). Both groups showed improvements in Global Rating of Change scale and pain rating scores, but between-group differences in scores for the Global Rating of Change scale (0 [CI, -2 to 1]) and pain rating (0.4 [CI, -0.5 to 1.2]) were not significant. During the 1-year follow-up, patients receiving CSI had more SIS-related visits to their primary care provider (60% vs. 37%) and required additional steroid injections (38% vs. 20%), and 19% needed physical therapy. Transient pain from the CSI was the only adverse event reported.

LIMITATIONS:
The study occurred at 1 center with patients referred to physical therapy.

CONCLUSION:
Both groups experienced significant improvement. The manual physical therapy group used less 1-year SIS-related health care resources than the CSI group.

PRIMARY FUNDING SOURCE:
Cardon Rehabilitation Products through the American Academy of Orthopaedic Manual Physical Therapists.