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Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general
J C Winters1, J S Sobel, K H Groenier
1Department of General Practice, University of Groningen, Netherlands.
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.
Results:
In the shoulder girdle group duration of complaints was significantly shorter after manipulation compared with physiotherapy (P < 0.001). Also the number of patients reporting treatment failure was less with manipulation. In the synovial group duration of complaints was shortest after corticosteroid injection compared with manipulation and physiotherapy (P < 0.001). Drop out due to treatment failure was low in the injection group (17%) and high in the manipulation group (59%) and physiotherapy group (51%).
Conclusions:
For treating shoulder girdle disorders, manipulation seems to be the preferred treatment. For the synovial disorders, corticosteroid injection seems the best treatment.