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Physiotherapy vs. corticosteroid injection for shoulder pain

posted Jan 8, 2015, 7:09 PM by Rebecca Smith
Shoulder pain is a common complaint and the annual incidence in general practice is estimated between 6.6 to 25 cases per 1000 cases. Most patients complaining of shoulder pain are treated in primary care with a course of analgesics and anti-inflammatory medications (NSAIDs), however, if this approach is unsuccessful the patient is often referred for physiotherapy or for a corticosteroid injection.

The most common shoulder complaints include shoulder impingement and shoulder stiffness (e.g. adhesive capsulitis). Common non-operative treatments for these complaints include exercise, manual therapy and corticosteroid injections. Recent systematic reviews have demonstrated beneficial effects in reducing pain levels and facilitating return to normal function with both exercise therapy and corticosteroid injections (Kuhn, 2009; Arroll & Goodyear-Smith, 2005). However, there is a lack of large clinical trials that evaluate the effect of both physiotherapy and corticosteroid injection as treatment for the painful shoulder. One reason for this may be attributable to the traditional model of service delivery where corticosteroid injections are delivered by a general practitioner and exercise or manual therapy is delivered by a physiotherapist. 

The current literature on the debate regarding whether one intervention is superior to the other demonstrates that both interventions are successful in improving pain levels. Although most studies demonstrated that the beneficial effects of corticosteroid injections to be slightly superior (mainly in respect to faster relief of symptoms), the intervention group that received corticosteroid injections demonstrated a much greater number of GP follow-up visits and future procedures compared to the physiotherapy intervention group (Rhon, Boyles & Cleland, 2004). Similarly, van der Windt et al. (1998) and Crawhsaw et al. (2010) demonstrated faster pain relief in the injection group compared to the physiotherapy group however; at final follow-up both intervention groups reported similar pain levels. These results were in agreement with previously published studies regarding corticosteroid injection and physiotherapy for shoulder pain. However, Crawshaw et al. (2010) demonstrated new evidence regarding the effects of physiotherapy and corticosteroid injection combined for patients complaining with shoulder pain. The study showed that, compared to physiotherapy or corticosteroid injection treatment alone, the combination therapy demonstrated significantly earlier improvements in pain and functional disability at one and six weeks.

In light of recent evidence, the literature suggests that a combination therapy of physiotherapy and corticosteroid injection treatment would yield significantly greater reductions in pain and improvements in function compared to a single course of either intervention. Corticosteroid injections may be advantageous in regards to reducing pain levels faster than physiotherapy alone, however, physiotherapy is necessary in the long term in order to maintain improvements in function and prevent the loss of strength and mobility which would inevitably lead to shoulder dysfunction and subsequent surgical intervention.

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