Both manual physical therapy (MPT) and subacromial corticosteroid injections (CSI) provide significant improvement in pain and function for patients with unilateral shoulder impingement syndrome (SIS), according to an article being published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/M14-0095).
SIS is a generic term that refers to various conditions that cause shoulder pain, including rotator cuff syndrome, tendinosis of the rotator cuff, and bursitis. Conservative treatment includes CSI or MPT, but evidence on the long-term efficacy of those treatments is conflicting.
Researchers randomly assigned 104 patients between the ages of 18 and 65 with SIS to receive either 40 mg triamcinolone acetonide subacromial CSI or six sessions of MPT. Patients in the CSI group were given up to three total triamcinolone acetonide injections during the 1-year study period. MPT was matched to individual impairments and included a combination of joint and soft-tissue mobilizations; manual stretches; contract-relax techniques; and reinforcing exercises directed to the shoulder girdle or thoracic or cervical spine. MPT patients completed six sessions over a 3-week period and home exercises were prescribed to reinforce clinical interventions. Patients reported pain and disability at 1 month, 3 months, 6 months, and a year. Patients in both groups experienced significant improvement in pain and function, but the MPT patients used less shoulder-related health care resources than the CSI group.