Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomised, single blind study

BMJ. 1997 May 3;314(7090):1320-5. doi: 10.1136/bmj.314.7090.1320.


Objective: To compare the efficacy of physiotherapy, manipulation, and corticosteroid injection for treating patients with shoulder complaints in general practice.

Design: Randomised, single blind study.

Setting: Seven general practices in the Netherlands.

Subjects: 198 patients with shoulder complaints, of whom 172 were divided, on the basis of physical examination, into two diagnostic groups: a shoulder girdle group (n = 58) and a synovial group (n = 114).

Interventions: Patients in the shoulder girdle group were randomised to manipulation or physiotherapy, and patients in the synovial group were randomised to corticosteroid injection, manipulation, or physiotherapy.

Main outcome measures: Duration of shoulder complaints analysed by survival analysis.

Results: In the shoulder girdle group duration of complaints was significantly shorter after manipulation compared with physiotherapy (P < 0.001). Also the number of patients reporting treatment failure was less with manipulation. In the synovial group duration of complaints was shortest after corticosteroid injection compared with manipulation and physiotherapy (P < 0.001). Drop out due to treatment failure was low in the injection group (17%) and high in the manipulation group (59%) and physiotherapy group (51%).

Conclusions: For treating shoulder girdle disorders, manipulation seems to be the preferred treatment. For the synovial disorders, corticosteroid injection seems the best treatment.

Publication types

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

MeSH terms

  • Anesthetics, Local / therapeutic use*
  • Drug Combinations
  • Family Practice
  • Follow-Up Studies
  • Glucocorticoids / therapeutic use*
  • Humans
  • Injections
  • Joint Diseases / drug therapy
  • Joint Diseases / rehabilitation
  • Joint Diseases / therapy
  • Lidocaine / therapeutic use*
  • Manipulation, Orthopedic
  • Pain / drug therapy
  • Pain / rehabilitation
  • Pain Management
  • Pain Measurement
  • Physical Therapy Modalities*
  • Shoulder Joint*
  • Single-Blind Method
  • Treatment Outcome
  • Triamcinolone Acetonide / therapeutic use*


  • Anesthetics, Local
  • Drug Combinations
  • Glucocorticoids
  • Lidocaine
  • Triamcinolone Acetonide