Tuesday, August 12, 2014 Physical Therapy as Effective as, Less Costly Than Steroids for Shoulder Pain A study published online in the August 7 Annals of Internal Medicine (abstract only available for free) has found that when it comes to shoulder impingement syndrome (SIS), physical therapy and steroid injections work equally well, but physical therapy is the less costly option. Researchers followed 104 patients with SIS who were split into 2 groups, the first group receiving up to 3 corticosteroid injections (CSIs) of 40 mg triamcinolone acetonide 1 month apart, and the second group receiving physical therapy twice weekly for 3 weeks and prescribed home exercises. Participants ranged in age from 18 to 65. After 1 year, researchers monitored changes to Shoulder Pain and Disability scores, as well as Global Rating of Change scores, Numeric Pain Rating Scale scores, and health care use. They found that both groups reported a 50% improvement in pain and disability scores; however, patients receiving CSIs had more SIS-related visits to their primary care provider than the physical therapy group (60% vs 37%) and required additional steroid injections at a rate higher than requests for additional physical therapy in the therapy group (38% vs 20%). The research, conducted at a military hospital-based outpatient clinic, is the first to directly compare the effectiveness of 2 common nonsurgical approaches to SIS, according to the study's authors. The study was primarily funded by Cardon Rehabilitation Products through the American Academy of Orthopaedic Manual Physical Therapists. News of the study appeared in Reuters, Healthfinder, WebMD, and Medscape (free access after registration), with the latter 2 publications mentioning possible limitations in the study that include demographic differences in subgroups and the fact that cost estimates were based on a military hospital setting that required no copayments. Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.