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.

Abstract

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.

Intervention: Random assignment into 2 groups: 40-mg triamcinolone acetonide subacromial CSI versus 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.

Limitation: 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.

Publication types

  • Comparative Study
  • Pragmatic Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Inflammatory Agents / therapeutic use*
  • Female
  • Humans
  • Injections, Intra-Articular
  • Male
  • Middle Aged
  • Physical Therapy Modalities*
  • Shoulder Impingement Syndrome / drug therapy
  • Shoulder Impingement Syndrome / therapy*
  • Single-Blind Method
  • Treatment Outcome
  • Triamcinolone Acetonide / therapeutic use*
  • Young Adult

Substances

  • Anti-Inflammatory Agents
  • Triamcinolone Acetonide

Associated data

  • ClinicalTrials.gov/NCT01190891