New research published August 4 in Annals of Internal Medicine reports that patients with shoulder pain receiving corticosteroid injections (CSI) vs manual physical therapy (MPT) had the same amount of symptom improvement, but the corticosteroid group used more healthcare resources. According to an accompanying editorial in the journal, these findings challenge the conclusions of a previous trial looking at patients with shoulder pain that found a CSI more cost-effective than physiotherapy.
The study found that patients assigned to receive injections had more physician visits and more additional injections compared with patients receiving manual therapy over the course of 1 year. Researchers followed 104 patients with unilateral shoulder impingement syndrome, with pathologies that included subacromial bursitis, rotator cuff tendinopathy, and partial rotator cuff tear. Patients in the MPT group were treated twice weekly over a 3-week period, by the same physical therapy in most cases. Home exercises were prescribed as well. Patients in the CSI group received an injection of 40 mg of triamcinolone acetonide to the subacromial space of the symptomatic shoulder. As many as three total injections, greater than one month apart, could be given by the study physician over the course of 1 year.