Comparison of subacromial corticosteroid injection and physical therapy in patients with subacromial impingement syndrome: A prospective, randomized trial

Abstract

The aim of this randomized trial was to evaluate the efficacy of subacromial corticosteroid injection and physical therapy (PT) in patients with subacromial impingement syndrome (SIS). Forty patients who diagnosed as SIS were included in this study and were randomly assigned to the PT and injection groups. Pain during rest, sleep and motion were evaluated by visual analog scale (VAS). Disability was determined by Costant- Murley score. Physical and social functions were evaluated with Short Form-36 (SF-36). Active range of motion (ROM) was measured by goniometer. Patients were evaluated at baseline, 3rd and 8th weeks of the therapy. PT continued for 3 weeks with ultrasound and interferential current combined to local heat and exercise. For patients in the injection group, a single steroid injection of 40 mg triamcinolone acetonide into the subacromial space was combined with exercise. After eight weeks, significant improvements at pain, SF-36 and Costant-Murley scores were observed in both groups (p<0.001). Improvement rates of pain during sleep and motion were significantly higher in PT group than the injection group after 8 weeks (p<0.01). Significant improvements were determined at ROM in both groups (p<0.001). No statistically significant differences were found between two groups in terms of Costant-Murley and ROM scores. Results of the PT group were significantly better in terms of physical and social function, and pain subscores of SF-36 (p<0.05). Our results suggest that both PT and corticosteroid injection have beneficial effects on shoulder mobility and pain relief in SIS. PT should be an alternative and effective treatment method to corticosteroid injection in SIS.

Shoulder specific exercise therapy is effective in reducing chronic shoulder pain: A network meta-analysis

“…Overall risk of bias assessment ( S4 Appendix ) for pain found 19 studies at high risk [ 34 , 38 , 39 , 41 , 43 , 45 – 48 , 57 – 59 , 64 , 66 , 70 , 78 , 79 , 81 , 84 ], 21 with some concerns [ 33 , 35 , 37 , 40 , 42 , 44 , 51 , 52 , 54 , 56 , 60 – 62 , 65 , 68 , 77 , 80 , 82 , 85 ] and 4 at low risk [ 53 , 71 , 73 , 74 ]. For ABD ROM, 9 studies had high risk [ 34 , 41 , 57 , 59 , 62 , 70 , 75 , 81 , 84 ] and 6 had some concerns [ 35 , 40 , 49 , 56 , 77 ,…”

“…For ABD ROM, 9 studies had high risk [ 34 , 41 , 57 , 59 , 62 , 70 , 75 , 81 , 84 ] and 6 had some concerns [ 35 , 40 , 49 , 56 , 77 , 85 ]. ER ROM had 12 studies with high risk [ 34 , 38 , 39 , 41 , 48 , 57 , 59 , 62 , 70 , 75 , 81 , 84 ] and 5 with some concerns [ 35 , 40 , 56 , 63 , 77 ]. SPADI consisted of 8 studies at high risk [ 32 , 38 , 43 , 59 , 75 , 76 , 83 , 84 ], 13 with some concerns [ 35 , 42 , 51 , 52 , 60 , 61 , 65 , 67 , 72 , 80 , 82 , 85 , 86 ] and 3 with low risk of bias […”

“…ROM (ER; ABD) included 917 and 894 participants post-intervention. The average ER for the shoulder was 67.38 degrees (Min 36.5 to Max 95) [ 34 , 35 , 38 – 41 , 46 , 56 , 57 , 59 , 62 , 70 , 75 , 77 , 81 , 84 ] and for abduction was 135.8 degrees (Min 9.33 to Max 179.5). [ 34 , 35 , 40 , 41 , 49 , 57 , 59 , 62 , 70 , 75 , 77 , 81 , 84 , 85 ] Shoulder-specific HRQL (SPADI, DASH) included 2,375 and 1,154 participants respectively post-intervention.…”

“…The average ER for the shoulder was 67.38 degrees (Min 36.5 to Max 95) [ 34 , 35 , 38 – 41 , 46 , 56 , 57 , 59 , 62 , 70 , 75 , 77 , 81 , 84 ] and for abduction was 135.8 degrees (Min 9.33 to Max 179.5). [ 34 , 35 , 40 , 41 , 49 , 57 , 59 , 62 , 70 , 75 , 77 , 81 , 84 , 85 ] Shoulder-specific HRQL (SPADI, DASH) included 2,375 and 1,154 participants respectively post-intervention. SPADI [ 32 , 35 , 38 , 42 , 43 , 49 – 52 , 59 – 61 , 65 , 67 , 69 , 72 – 74 , 76 , 80 , 82 – 86 ] average was 30.22 points (Min 10.1 to Max 61.4) and for DASH [ 32 , 34 , 36 , 37 , 44 , 47 ,…”