State of the Art Corticosteroid therapy versus physiotherapy on pain, mobility and function in shoulder impingement: A short note

Natalie Benjamin-Damons, Naeema A.R. Hussein El Kout, Rogier van Bever Donker, Tamsen Edwards, Gillian Ferguson

South African Journal of Physiotherapy | Vol 78, No 1 | a1794 | DOI: https://doi.org/10.4102/sajp.v78i1.1794 | © 2022 Natalie Benjamin-Damons, Naeema A.R. Hussein El Kout, Rogier van Bever Donker, Tamsen Edwards, Gillian Ferguson | This work is licensed under CC Attribution 4.0
Submitted: 23 May 2022 | Published: 12 December 2022

About the author(s) Natalie Benjamin-Damons, Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Professional Development Portfolio, The South African Society of Physiotherapy, Johannesburg, South Africa
Naeema A.R. Hussein El Kout, Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Professional Development Portfolio, The South African Society of Physiotherapy, Johannesburg, South Africa
Rogier van Bever Donker, Professional Development Portfolio, The South African Society of Physiotherapy, Johannesburg, South Africa; and, Department of Physiotherapy, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Tamsen Edwards, Professional Development Portfolio, The South African Society of Physiotherapy, Johannesburg, South Africa
Gillian Ferguson, Professional Development Portfolio, The South African Society of Physiotherapy, Johannesburg, South Africa; and, Department of Physiotherapy, Faculty of Health Sciences, University of Cape Town, Johannesburg, South Africa

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Abstract

Background: The global estimate of shoulder pain is 67% and is often associated with subacromial impingement syndrome. Interventions include corticosteroid injection (CSI) therapy and physiotherapy. Further information is needed to compare the effect of these interventions on pain, joint range of motion (ROM) and shoulder function.

Objectives: To summarise the best evidence comparing the effect of CSI versus physiotherapy on pain, shoulder ROM and shoulder function in patients with subacromial impingement syndrome.

Method: This evidence statement is based on a systematic review and meta-analysis of three randomised controlled trials (RCTs), namely, Rhon et al. (2014) (n = 136), Hay et al. (2003) (n = 207) and Van der Windt et al. (1998) (n = 109), with a total of 452 participants. A total of 14 studies were reviewed and only 3 studies met the inclusion criteria.

Results: An improvement in shoulder function was found in favour of CSI at 6- to 7-week follow-up (p < 0.0001), but no evidence was found for the superiority of CSI compared to physiotherapy for pain and ROM over 4–12 weeks. In 24 and 48 weeks, no evidence was found for the superiority of CSI compared to physiotherapy for shoulder function, pain or ROM.

Conclusion: No evidence was found for the superiority of CSI compared to physiotherapy for pain and ROM in the short term besides an improvement in shoulder function in favour of CSI at 6–7 weeks. There was a weak recommendation with moderate quality of evidence based on three RCTs (2B).

Clinical implications: This evidence statement may inform clinical practice when determining which intervention is best suited to manage patients with shoulder pain.

Keywords

shoulder pain; corticosteroid injections; physiotherapy; evidence statement; subacromial impingement syndrome

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