One-year outcome of subacromial corticosteroid injection versus manual physical therapy for unilateral shoulder impingement syndrome: a pragmatic randomized clinical trial

Background: Corticosteroid injections (CSI) and physical therapy are often used to treat shoulder impingement syndrome, but their effectiveness has never been directly compared out to one year. Purpose:Theprimarypurposeof this studywas to directly compare the effectiveness of 2 common nonsurgical treatment approaches for shoulder impingement syndrome. The secondary purpose was to compare 1year healthcare utilization between the two groups. Methods: Patients referred to physical therapy received random assignment into 2 groups: 40mg triamcinalone acetonide subacromial CSI versus 6 sessions of manual physical therapy (MPT). Follow-up occurred at 1, 3, 6, and 12months. TheShoulder Pain andDisability Index (SPADI) served as the primary outcome. Secondary outcomes included the Global Rating of Change (GRC), the Numeric Pain Rating Scale (NPRS), and 1-year healthcare utilization based off electronic medical records review. Results:Over an 18-month period, 104 consecutive adults between 18 and 65 years of age with unilateral shoulder impingement were enrolled. Both groups demonstrated ∼50% improvement in SPADI at all 4 follow-ups maintained through 1 year, howevermean difference between groupswas not significant (1.5 [95% CI: 6.3, 9.4]). Both groups showed improvements in GRC and NPRS, but between group differences for the GRC (0 [95% CI: 2, +1]) and NPRS (0.4 [95% CI: 0.5, 1.2]) were not significant. During the 1-year followup, patients receiving CSI hadmore SIS-related visits to their primary care provider (60% vs. 37%), required additional steroid injections (38% vs. 20%), and 19% needed physical therapy (compared to 9% in the MPT group). Conclusion(s): Patients randomized to the MPT group experienced similar outcomes in terms of function, pain and patient perceived improvement as patients receiving CSI. However they utilized significantly less additional healthcare resources than the CSI patients for the following year after initial treatment. Implications: CSI and MPT are two common conservative treatment options offered to patients with shoulder impingement. Understanding their long-term impact and the comparative effectiveness of each can help guide best evidence care decisions. Disclaimer:The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Departments of the Army or Defense.