title: 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.
abstract: BACKGROUND
  Corticosteroid injections (CSIs) and physical therapy are used to treat patients with the shoulder impingement syndrome (SIS) but have never been directly compared.
  
  
  OBJECTIVE
  To compare the effectiveness of 2 common nonsurgical treatments for SIS.
  
  
  METHODS
  Randomized, single-blind, comparative-effectiveness, parallel-group trial. (ClinicalTrials.gov: NCT01190891).
  
  
  METHODS
  Military hospital-based outpatient clinic in the United States.
  
  
  METHODS
  104 patients aged 18 to 65 years with unilateral SIS between June 2010 and March 2012.
  
  
  METHODS
  Random assignment into 2 groups: 40-mg triamcinolone acetonide subacromial CSI versus 6 sessions of manual physical therapy.
  
  
  METHODS
  The primary outcome was change in Shoulder Pain and Disability Index scores at 1 year. Secondary outcomes included the Global Rating of Change scores, the Numeric Pain Rating Scale scores, and 1-year health care use.
  
  
  RESULTS
  Both groups demonstrated approximately 50% improvement in Shoulder Pain and Disability Index scores maintained through 1 year; however, the mean difference between groups was not significant (1.5% [95% CI, -6.3% to 9.4%]). Both groups showed improvements in Global Rating of Change scale and pain rating scores, but between-group differences in scores for the Global Rating of Change scale (0 [CI, -2 to 1]) and pain rating (0.4 [CI, -0.5 to 1.2]) were not significant. During the 1-year follow-up, patients receiving CSI had more SIS-related visits to their primary care provider (60% vs. 37%) and required additional steroid injections (38% vs. 20%), and 19% needed physical therapy. Transient pain from the CSI was the only adverse event reported.
  
  
  CONCLUSIONS
  The study occurred at 1 center with patients referred to physical therapy.
  
  
  CONCLUSIONS
  Both groups experienced significant improvement. The manual physical therapy group used less 1-year SIS-related health care resources than the CSI group.
  
  
  BACKGROUND
  Cardon Rehabilitation Products through the American Academy of Orthopaedic Manual Physical Therapists.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Rhon
authors.forename: Robert B
authors.initials: RB
authors.lastname: Boyles
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Cleland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D019534:Shoulder Impingement Syndrome / Q000188:drug therapy / Q000628:therapy*; D016037:Single-Blind Method; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D014222:Triamcinolone Acetonide