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Editorials |5 August 2014

Pragmatic Study of Corticosteroid Injections and Manual Physical Therapy for the Shoulder Impingement Syndrome

Brooke K. Coombes, PhD; Bill Vicenzino, PhD

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Author, Article, and Disclosure Information
  • 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.

    Requests for Single Reprints: Bill Vicenzino, PhD, School of Health and Rehabilitation Sciences, University of Queensland, Therapies Building 84A, St. Lucia, Brisbane 4072, Australia; e-mail, b.vicenzino@uq.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.

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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 were substantial differences in health care use. After initial care, patients assigned to injection had significantly more consultations with their physician (60%) than those in the manual physical therapy group (37%). This included referral to physical therapy in 19% of patients who received injections. Overall, this study had a low risk of bias, and conclusions were in agreement with previous research.
The shoulder impingement syndrome is the most commonly diagnosed disorder of the shoulder, accounting for 41% of all cases of shoulder pain resulting in a physician visit (2). Despite the high prevalence of SIS, the terminology, classification, and diagnostic criteria for SIS are fraught with issues and controversy. For example, SIS is not a single entity but rather includes many pathologies, such as subacromial bursitis, rotator cuff tendinopathy, and partial rotator cuff tear. Various physical tests are advocated, but it is difficult to differentiate among the types of...
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Coombes BK, Vicenzino B. Pragmatic Study of Corticosteroid Injections and Manual Physical Therapy for the Shoulder Impingement Syndrome. Ann Intern Med. 2014;161:224–225. doi: 10.7326/M14-1405

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Published: Ann Intern Med. 2014;161(3):224-225.

DOI: 10.7326/M14-1405

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