Steroid Injection, Physical Therapy Equally Effective in Acute Shoulder Pain
References: Ann Rheum Dis. 2003;62:385-387, 394-399
Steroid injection or physical therapy offers similar outcomes for the treatment of acute unilateral shoulder pain, according to the results of a randomized trial published in the May issue of the Annals of Rheumatic Diseases. The editorialists put this in the context of other studies and agree with the investigators that patients' perceptions should be incorporated into treatment decisions. "Systematic reviews of randomised controlled trials evaluating treatments for shoulder problems have been inconclusive about their clinical and cost effectiveness," write E. M. Hay, from Staffordshire Rheumatology Centre in Stoke-on-Trent, U.K., and colleagues. "Overall, the best evidence relates to the use of local steroid injections." Over 22 months, 207 adults with shoulder pain were randomized to practice-based physical therapy or to local steroid injections administered by general practitioners. A study nurse blinded to treatment group performed baseline and follow-up assessments. Mean improvements in disability scores at six weeks were 2.56 ± 5.4 for the physical therapy group and 3.03 ± 6.3 for the injection group, and at six months scores were 5.97 ± 5.4 and 4.55 ± 5.9, respectively. At six months, 59 (60%) of 99 patients in the physical therapy group and 51 (53%) of 97 patients in the injection group had a successful outcome, defined as at least a 50% drop in the disability score from baseline (percentage difference = 7%; 95% confidence interval, -6.8% to 20.4%). "Community physiotherapy and local steroid injections were of similar effectiveness for treating new episodes of unilateral shoulder pain in primary care, but those receiving physiotherapy had fewer co-interventions," the authors write. Although the reasons for lower reconsultation rate during follow-up in the physical therapy group are unclear, the authors noted that it reduced their workload with no change in overall patient outcome. They recommend that patients and clinicians deciding on acute treatment for shoulder problems consider personal preference, availability of physical therapy and/or of doctors trained in injection, need for cointerventions, and concerns about the long-term effectiveness of steroid injections.