| Methods |
Randomised controlled trial.
Blinding:
Only outcome assessors were blinded. Patients unable to be blinded since comparing steroid injections to physiotherapy.
Loss to follow‐up: 2 (3.6%) patients withdrew from physiotherapy treatment group and 4 (7.5%) withdrew from injection group
Appropriate statistical analysis: Yes ‐ intention to treat analysis. |
| Participants |
109 patients
Inclusion criteria:
1) painful restriction of glenohumeral mobility ‐ lateral rotation must be relatively more limited than abduction and medial rotation and must be no clear signs (painful arc, positive resistance tests, loss of power) that shoulder pain is caused by another condition;
2) 18 yrs or older; 3) informed consent. Exclusion criteria:
1) bilateral shoulder symptoms;
2) treatment with physiotherapy or corticosteroid injections during preceding 6 months;
3) contra
indications to treatment;
4) surgery, dislocation or fracture of shoulder area;
5) insulin dependent diabetes mellitus;
6) systemic disorders of musculoskeletal system or neurological disorders. |
| Interventions |
Group 1 (53 patients) Intra‐articular injections of 40mg triamcinolone acetonide, posterior route, by mostly trained general practitioners. No more than 3 injections were given during 6 week treatment period.
Group 2 (56 patients): 12 sessions of physiotherapy over 6 weeks, consisting of 30 minutes of passive joint mobilisation and exercise treatment. Ice, hot packs, or electrotherapy could also be used to reduce pain. No ultrasound, acupuncture or high velocity thrust manipulations were allowed under the protocol. Treatment could be adjusted according to severity of symptoms.
All patients in both groups allowed to could continue taking drugs for pain if they had started before enrollment; drugs could also be prescribed if pain was severe. All other interventions were to be avoided during study. |
| Outcomes |
Assessments made at baseline, 3, 7, 13, 26 and 52 weeks.
1) Patients scored their improvement on a 6‐point Likert scale. For analysis of success rates for each treatment, patients who rated themselves as having made a complete recovery or as having much improved were counted as successes.
2) Patients were asked to score the pain associated with their main complaint
3) severity of their pain during the day and at night on 100mm visual analogue scale (VAS) where 0 = no pain and 100 = very severe pain.
4) Functional disability was assessed using shoulder disability questionnaire, a 16‐item scale consisting of common situations which migh cause shoulder pain. Scores on this ranged from 0 (no disability) to 100 (severe disability).
5) Independent observer scored overall clinical severity of the disorder on VAS. Using the healthy shoulder as a reference, the observer measured the restriction of mobility during passive lateral rotation and glenohumeral abduction with a digital inclinometer (EDI‐320, Cybex, Ronkonkoma, New York). |
| Notes |
See analyses 5. |
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Allocation concealment? |
Low risk |
A ‐ Adequate |
