Pragmatic Study of Corticosteroid Injections and Manual Physical Therapy for the Shoulder Impingement Syndrome
Authors: Brooke K. Coombes, Bill Vicenzino
Journal: Annals of Internal Medicine (2014)

Editorials5 August 2014Pragmatic Study of Corticosteroid Injections and Manual Physical Therapy for the Shoulder Impingement SyndromeBrooke K. Coombes, PhD and Bill Vicenzino, PhDBrooke K. Coombes, PhDFrom University of Queensland, St. Lucia, Brisbane, Australia.Search for more papers by this author and Bill Vicenzino, PhDFrom University of Queensland, St. Lucia, Brisbane, Australia.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-1405 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this issue, Rhon and colleagues (1) report on their study of patients with the unilateral shoulder impingement syndrome (SIS) referred to a military hospital–based outpatient clinic in the United States. This single-blind, randomized trial with 1-year follow-up compared a single corticosteroid injection with six 30-minute sessions (over 3 weeks) of manual physical therapy. It was a pragmatic trial, and after 1 month, primary care providers could prescribe other treatments if clinically indicated, a design that reflects the real-world experiences of persons who seek treatment. Although primary clinical outcomes showed no differences in the improvements gained after both treatments, there ...References1. 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;161:161-9. doi:10.7326/M13-2199 LinkGoogle Scholar2. van der Windt DA, Koes BW, de Jong BA, Bouter LM. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis. 1995;54:959-64. [PMID: 8546527] CrossrefMedlineGoogle Scholar3. Hanchard NC, Lenza M, Handoll HH, Takwoingi Y. Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement. Cochrane Database Syst Rev. 2013;4:CD007427. [PMID: 23633343] doi:10.1002/14651858.CD007427.pub2 CrossrefMedlineGoogle Scholar4. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333:939. [PMID: 17012266] CrossrefMedlineGoogle Scholar5. Thomas E, van der Windt DA, Hay EM, Smidt N, Dziedzic K, Bouter LM, et al. Two pragmatic trials of treatment for shoulder disorders in primary care: generalisability, course, and prognostic indicators. Ann Rheum Dis. 2005;64:1056-61. [PMID: 15640264] CrossrefMedlineGoogle Scholar6. James M, Stokes EA, Thomas E, Dziedzic K, Hay EM. A cost consequences analysis of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care. Rheumatology (Oxford). 2005;44:1447-51. [PMID: 16091398] CrossrefMedlineGoogle Scholar7. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376:1751-67. [PMID: 20970844] doi:10.1016/S0140-6736(10)61160-9 CrossrefMedlineGoogle Scholar8. van der Windt DA, Koes BW, Devillé W, Boeke AJ, de Jong BA, Bouter LM. Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care: randomised trial. BMJ. 1998;317:1292-6. [PMID: 9804720] CrossrefMedlineGoogle Scholar9. Hay EM, Thomas E, Paterson SM, Dziedzic K, Croft PR. A pragmatic randomised controlled trial of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care. Ann Rheum Dis. 2003;62:394-9. [PMID: 12695148] CrossrefMedlineGoogle Scholar10. Cummins CA, Sasso LM, Nicholson D. Impingement syndrome: temporal outcomes of nonoperative treatment. J Shoulder Elbow Surg. 2009;18:172-7. [PMID: 19095464] doi:10.1016/j.jse.2008.09.005 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Queensland, St. Lucia, Brisbane, Australia.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1405.Corresponding Author: Bill Vicenzino, PhD, School of Health and Rehabilitation Sciences, University of Queensland, Therapies Building 84A, St. Lucia, Brisbane 4072, Australia; e-mail, b.[email protected]edu.au.Current Author Addresses: Drs. Coombes and Vicenzino: School of Health and Rehabilitation Sciences, University of Queensland, Therapies Building 84A, St. Lucia, Brisbane 4072, Australia. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoOne-Year Outcome of Subacromial Corticosteroid Injection Compared With Manual Physical Therapy for the Management of the Unilateral Shoulder Impingement Syndrome Daniel I. Rhon , Robert B. Boyles , and Joshua A. Cleland One-Year Outcome of Subacromial Corticosteroid Injection Compared With Manual Physical Therapy for the Management of the Unilateral Shoulder Impingement Syndrome Daniel I. Rhon , Robert B. Boyles , and Joshua A. Cleland Metrics Cited byA systematic review of thrust manipulation for non-surgical shoulder conditionsThe incidence of flare reaction and short-term outcome following steroid injection in the shoulderShoulder injuries in volleyball 5 August 2014Volume 161, Issue 3Page: 224-225KeywordsClinical trialsCorticosteroid therapyExerciseExercise therapyHealth carePathology and laboratory medicinePatientsPhysiotherapyShoulders ePublished: 5 August 2014 Issue Published: 5 August 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...