Shoulder Impingement – Physical Therapy versus Steroid Shots

July 8, 2016 in STSMPT

Shoulder Impingement Therapy

In the first-ever study comparing physical therapy to steroid injections for shoulder impingement syndrome, the outcomes for pain and disability were the same. However, physical therapy may do more to address the underlying cause while also giving patients greater ability and confidence in future self-management.


Shoulder impingement syndrome is used as a generic term to encompass rotator cuff syndrome, tendinosis of the rotator cuff muscles, and shoulder bursitis.  Among 104 randomized patients, both groups showed clinically significant improvement as measured by the Shoulder Pain and Disability Index (SPADI). Both treatments created a roughly 50% improvement in the SPADI score in one month and maintained that improvement at three, six, and twelve month follow-up.


The main difference between the groups is that patients receiving physical therapy proved far less likely to seek additional treatment. Compared to patients receiving injections, physical therapy patients were 38% less likely to have shoulder-related doctor visits that were not part of the study treatments, additional shots, additional physical therapy, or other healthcare services related to the shoulder impingement syndrome. This difference stands out since both groups apparently achieved the same success in pain and disability improvement in one month and both maintained that success. The authors theorize that largely passive treatments may encourage dependence on professional intervention while physical therapy may teach and empower patients to self-manage more effectively and more confidently. Differences may also manifest in that physical therapy programs can be designed to directly address the underlying problem, and thereby do more to thwart the progression of shoulder impingement syndrome.


In this study patients received up to two visits per week for up to three weeks. Patients received a combination of joint and soft-tissue mobilizations, manual stretches, contract-relax techniques, and reinforcing exercises directed to the shoulder girdle and thoracic or cervical spine. They also received a home exercise plan. Patients in the injection arm received one to three injections of 40 mg triamcinolone acetonide at least one month apart. Injection patients also received printed instructions for distraction and pendulum exercises.


The study adds encouragement to consider physical therapy instead of or in addition to steroid injections in the treatment of shoulder impingement syndrome. Physical therapy promises equally effective improvements in pain and disability plus an intention to empower patients in self management while decreasing the progression of the disease.


Source: Rhon D, Boyles R, Cleland J. One-year outcome of subacromial corticosteroid injection compared with manual physical therapy for the management of the unilateral shoulder impingement syndrome: a pragmatic randomized trial. Annals of Internal Medicine. 2014 Aug 5;161(3):161-9.

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