Exercise therapy alone and exercise therapy after corticosteroid injection are equally effective after 12 weeks for moderate to severe shoulder pain.

摘要

Question: Does subacromial corticosteroid injection combined with timely exercise and manual therapy (injection plus exercise) or exercise and manual therapy alone (exercise only) improve shoulder pain and disability in patients with subacromial impingement syndrome? Design: A pragmatic randomised, controlled trial with block randomisation and group allocation by using an independent telephone randomisation service. Setting: Primary care based musculoskeletal service in UK. Participants: Men and women 40 years or older with unilateral shoulder pain with moderate or severe pain intensity on a 3-point scale, and with a non-capsular pattern of restriction. Key exclusion criteria were evidence of other pathological conditions in the shoulder and neck. Randomisation of 232 participants allocated 115 to the 'injection plus exercise' group and 117 to the 'exercise only' group. Interventions: Both groups received standard advice to avoid activities that caused or provoked pain. The physiotherapy program started one week after the subacromial injection or immediately in the exercise only arm. The training sessions were individually adapted and comprised a selection of six mobilisation techniques and 23 progressive exercises. The patients attended as many sessions as deemed necessary by the treating physiotherapist. In addition, the intervention group received one injection of 20 mg triamcinolone acetonide mixed with 4.5 ml 1% lidocaine (lignocaine) at the midpoint of the acromion, which could be repeated after six weeks in patients with ongoing pain. Outcome measures: The primary outcome was the difference in improvement in the total shoulder pain and disability index (SPADI) at 12 weeks. The secondary outcome measure was global assessment of change on a 5-point scale. Results: 193 of participants completed the study, 96 in the 'injection plus exercise' group and 97 to the 'exercise only' group. At Week 12 there was no significant difference between the groups in change i...