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.

The objective of this research was to study the course of the pain and the restriction of mobility of the scapulohumeral joint (ROM) over time, and the factors influencing it, in patients with shoulder complaints in general practice. A total of 101 patients participated in this 25-week follow-up study. For the first 2 weeks, a non-steroidal anti-inflammatory drug (NSAID) was prescribed, after that period the physician could follow his usual therapeutic approach. The NSAIDs prescribed during the first 2 weeks resulted in a rapid decrease in the pain and the ROM. The group with the most severe pain consumed the most tablets, which resulted in a significant decrease in the pain and the ROM. It appeared that the course of the pain from week 2 to week 8 was significantly influenced by pain at inclusion, diagnosis and therapy. The most rapid decrease in the ROM appeared in the first 2 weeks. At week 0 and week 2, differences, in the ROM were seen in the subgroups for diagnosis pain score and age. The pain and the ROM showed most decrease in the first weeks. After 6 weeks hardly any changes were seen in the pain score and the ROM score. The margin of the pain score and the ROM score between the "cured" and the "not cured" patients was a very narrow one.