Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care: randomised trial

Objective to compare the effectiveness of corticosteroid injections with physiotherapy for the treatment of painful stiff shoulder. Design Randomised trial. Setting 40 general practices. Subjects 109 patients consulting general practitioners for shoulder pain were enrolled in the trial. Interventions Patients were randomly allocated to 6 weeks of treatment either with corticosteroid injections (53) or physiotherapy (56). Main outcome measures Outcome assessments were carried out 3, 7, 13, 26, and 52 weeks after randomisation; some of the assessments were done by an observer blind to treatment allocation. Primary outcome measures were the success of treatment as measured by scores on scales measuring improvement in the main complaint and pain, and improvement in scores on a scale measuring shoulder disability. Results At 7 weeks 40 (77%) out of 52 patients seared with injections were considered to be treatment successes compared with 26 (46%) out of 56 treated with physiotherapy (difference between groups 31%, 95% confidence interval 14% to 48%). The difference in improvement favoured those treated dth corticosteroids in nearly all outcome measures; these differences were statistically significant At 26 and 52 weeks differences between the groups were comparatively small. Adverse reactions wee generally mild However among women receiving treatment with corticosteroids adverse reactions were mure troublesome: facial flushing was reported by 9 women and irregular menstrual bleeding by 6, 2 of whom were postmenopausal. Conclusions The beneficial effects of corticosteroid injections administered by general practitioners for treatment of painful stiff shoulder are superior to those of physiotherapy. The differences between the intervention groups were mainly the result of the comparatively faster relief of symptoms that occurred in patients treated with injections. Adverse reactions were generally mild but doctors should be aware of the potential side effects of injections of triamcinolone, particularly in women.