What did the study look at?
Subacromial impingement syndrome is a painful condition in which the space between the roof of the shoulder (acromion) and the upper arm bone narrows when the arm is raised, squeezing the bursae and tendons there. As the article notes, treatment is primarily non-surgical (conservative), and the two most commonly chosen methods are exercise and corticosteroid injection.
The aim was to compare physiotherapy alone with physiotherapy combined with a subacromial corticosteroid injection in treating this syndrome.
How was it done?
- 56 patients aged 30–65 who presented with shoulder pain in 2016–2017, were diagnosed with impingement on examination and MRI, and had no rotator cuff tear were included.
- The diagnosis was confirmed with the Neer and Hawkins-Kennedy tests, repeated after a local anaesthetic injection.
- Patients with shoulder arthritis, full or partial tendon tears, inflammatory arthritis, fibromyalgia, frozen shoulder, previous shoulder fracture or dislocation, previous treatment for this diagnosis or a history of cancer were not included.
- Patients were allocated by their own preference: Group 1 (26 patients) received physiotherapy only; Group 2 (30 patients) also received two subacromial corticosteroid injections two weeks apart.
- All patients followed a 10-week, two-phase physiotherapy programme.
- Pain was measured with a Visual Analogue Scale (VAS; 0–100) and function with the ASES score before treatment and at 3, 6 and 12 months.
What did it find?
- At 3 and 6 months, VAS and ASES scores were significantly better in the injection group (p<0.001). At 6 months, for example, mean VAS was 39.18 in Group 1 and 20.33 in Group 2.
- At 12 months the differences between groups were not significant for VAS (p=0.539) or ASES (p=0.117).
- Mean VAS fell from 68.87 to 31.08 at 12 months in Group 1 and from 66.11 to 29.43 in Group 2.
- Mean ASES rose from 44.21 to 74.56 in Group 1 and from 42.27 to 78.73 in Group 2.
The authors' conclusion
The author concludes that physiotherapy combined with corticosteroid injection appears more effective in the short term than physiotherapy alone, but that both methods reduced pain and improved function. He notes that, as there is no internationally accepted algorithm for this condition, a patient-based approach should also be considered when choosing treatment.
Limitations
- There was no double-blind design for the injection.
- Different injection protocols for timing and dose were not compared.
- Follow-up was short.
Reference
Gürsoy S. Kortikosteroid enjeksiyonunun subakromiyal sıkışma sendromunun konservatif tedavisinde etkinliği [Efficacy of corticosteroid injection in the conservative treatment of subacromial impingement syndrome]. Ankara Medical Journal. 2018;18(4):683–689. Article in Turkish with an English abstract.
DOI: 10.17098/amj.501834
Free full text: DergiPark – Ankara Medical Journal (PDF)
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
