title: Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomised, single blind study.
abstract: OBJECTIVE
  To compare the efficacy of physiotherapy, manipulation, and corticosteroid injection for treating patients with shoulder complaints in general practice.
  
  
  METHODS
  Randomised, single blind study.
  
  
  METHODS
  Seven general practices in the Netherlands.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of General Practice, University of Groningen, Netherlands.
authors.forename: J C
authors.initials: JC
authors.lastname: Winters
authors.forename: J S
authors.initials: JS
authors.lastname: Sobel
authors.forename: K H
authors.initials: KH
authors.lastname: Groenier
authors.forename: H J
authors.initials: HJ
authors.lastname: Arendzen
authors.forename: B
authors.initials: B
authors.lastname: Meyboom-de Jong
mesh_terms: D000779:Anesthetics, Local / Q000627:therapeutic use*; D004338:Drug Combinations; D005194:Family Practice; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D007592:Joint Diseases / Q000188:drug therapy / Q000534:rehabilitation / Q000628:therapy; D008012:Lidocaine / Q000627:therapeutic use*; D008349:Manipulation, Orthopedic; D010146:Pain / Q000188:drug therapy / Q000534:rehabilitation; D059408:Pain Management; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D012785:Shoulder Joint; D016037:Single-Blind Method; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; D005938:Glucocorticoids; D008012:Lidocaine; D014222:Triamcinolone Acetonide