Physical therapy and
steroid injections work equally well for shoulder pain, according to a new
study.
Researchers compared the treatments for people with shoulder
impingement syndrome, a common type of persistent pain that can be caused by
tendonitis, bursitis or other inflammation in the shoulder joint. “Interestingly,
there is not standardized treatment for this and it can vary,” said lead author
Daniel I. Rhon, a physical therapist at the Center for the Intrepid at Brooke
Army Medical Center in Fort Sam Houston, Texas.
“I think there is a strong consensus that exercises can
help, and patients may also get a referral to physical therapy for this
condition,” Rhon told Reuters Health in an email. “Because of the pain and
inflammation that is sometimes present with shoulder impingement,
corticosteroid injections are also a very common treatment used by general
practitioners, orthopedists, and rheumatologists.”Some doctors send patients to
physical therapy and others don’t, while still others will give a shot and also
recommend physical therapy, he said. Patients have some say in which treatment
they get, but doctors usually influence the choice.
Rhon and his team randomly divided 104 patients with this
kind of pain into two groups. One group received physical therapy twice a week
for three weeks. The therapists evaluated weakness, mobility and pain and
performed stretches, contract-relax techniques and reinforcing exercises on the
shoulder or upper spine area. They also prescribed at-home exercises for the
patients.Patients in the other group were offered up to three injections of
corticosteroids over the course of a year. They also received printed
instructions for gentle exercises to do at home.
Both groups had significant improvement in symptoms after one
month, which continued over the one-year period of the study, the research team
reported in the Annals of Internal Medicine. Patients’ scores on pain and
disability were reduced by half with either treatment.By the end of the year,
60 percent of the steroid injection group had returned to their primary care
doctor for shoulder pain again, compared to 37 percent of the physical therapy
group. The injection group was also more likely to end up having more injections
or additional physical therapy.
The research was supported by funding from the American
Academy of Orthopaedic Manual Therapists.“In the clinic I often see patients
that have had multiple injections and continue to have persistent pain - thus
their referral to physical therapy,” Rhon said. “I was curious to understand a
little more about this.”
“Only half of all new episodes (of shoulder impingement) end
in complete recovery after six months, indicating it is a serious health
problem,” said Brooke K. Coombes, who coauthored an editorial accompanying the
study. Coombes studies rehabilitation medicine in the physiotherapy department
of the University of Queensland in Brisbane, Australia.
She was not surprised that steroid injections and physical
therapy worked about equally well. The relief from an injection may not last as
long, leading to more treatments, or the physical therapy appointments may give
doctors more time to educate patients about dealing with shoulder pain, Coombes
told Reuters Health by email.“Physical therapy involves more patient-clinician
contact than a single consultation at which an injection is given,” she said.
“This may allow for advice or reassurance about the condition and
self-management approaches.”
Injections are less costly than therapy because they only
involve one visit to the doctor rather than several therapy sessions, but if
they also result in more doctor visits down the line, that may end up balancing
out costs, she said.Certain people may benefit more from steroid injections
than physical therapy, or vice versa, but that will need to be researched more,
she said.
“One thing to point out is that the number one reason that
patients turned down participation in this study was because they did not want
to be randomized into a group that might receive an injection,” Rhon said.
“This suggests that there is a number
of patients that really don't want to get an injection.”
Physical therapy is an excellent
treatment option to consider for these patients, he said.
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