Effect of corticosteroid injections versus physiotherapy on pain, shoulder range of motion and shoulder function in patients with subacromial impingement syndrome: A systematic review and meta-analysis.
Marlette Burger, Carly Africa, Kara Droomer and 5 others
PMID 30135893WHAT IT FOUND
Physiotherapy and steroid injections both improve pain, motion and function in subacromial impingement syndrome.
Steroid injections showed a small short-term advantage in function at 6-7 weeks, but this difference disappeared by 6 months. There is no evidence that injections are superior to physiotherapy in the medium or long term.
Key findings
01Steroid injections provided a statistically significant improvement in shoulder function compared to physiotherapy at 6-7 weeks, but this advantage was not present at 6 months or 1 year.
02There was no significant difference between steroid injections and physiotherapy for pain, range of motion, or function at medium-term (6 months) or long-term (12 months) follow-up.
03Both treatments resulted in clinically important improvements in pain and function from baseline, with no evidence that one approach is superior overall.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only three RCTs were included, which limits the generalizability of the findings. Blinding of participants and therapists was not possible due to the nature of the interventions. One included study did not blind the assessors, which could introduce bias. There was significant heterogeneity in the physiotherapy interventions (e.g., use of ultrasound vs. manual therapy only) and injection protocols (number of injections, timing). Pain and ROM data could not be pooled due to heterogeneity in reporting, relying instead on narrative summaries. The studies excluded patients with previous shoulder injuries, rotator cuff tears, or adhesive capsulitis, so results may not apply to these populations.
Declared interests
No specific funding sources or conflicts of interest were declared in the provided text.
The easy way to misread this
Do not interpret the short-term functional advantage of steroid injections at 6-7 weeks as evidence that they are the superior treatment overall. This benefit was transient and disappeared by 6 months, and there was no consistent evidence that injections provided better pain relief or range of motion than physiotherapy in the long term.