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Nazary-Moghadam S, Tehrani MR, Kachoei AR, Golmohammadzadeh S, Moradi A, Zare MA, Zeinalzadeh A. Comparative effect of triamcinolone/lidocaine ultrasonophoresis and injection on pain, disability, quality of life in patients with acute rotator cuff related shoulder pain: a double blinded randomized controlled trial. Physiother Theory Pract 2024:1-9. [PMID: 38368597 DOI: 10.1080/09593985.2024.2316307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 01/14/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Alleviating inflammation should be considered as one of the first steps of the treatment plan in patients with acute rotator cuff related shoulder pain (RCRSP). OBJECTIVE To compare the effects of triamcinolone/lidocaine ultrasonophoresis, injection on pain, disability, and quality of life in patients with acute RCRSP. METHODS A total of 28 acute RCRSP patients were randomly allocated into two groups of ultrasonophoresis and injection. Both groups received vitamin C and shoulder care education for 10 days and then were subjected to therapeutic interventions. Ultrasonophoresis group received triamcinolone (16 mg) and lidocaine (2mg) using ultrasonophoresis (frequency: 3 MHz, intensity: 1.50 W/Cm2), while the injection group received a single subacromial injection of triamcinolone (80 mg) and lidocaine (10 mg). The main outcomes measures were pain assessed by two scales (visual analog scale), and shoulder pain and disability index (SPADI), disability (SPADI), and quality of life (Western Ontario rotator cuff questionnaire). RESULTS Although the main effect of time was statistically significant for all dependent variables (P< 0.01), no significant interaction was found between group and time (P-value (0.12-0.55)). The ultrasonophoresis effect, size for pain, disability, and quality of life were 2.58, 1.43, 1.78, and 1.35, respectively. The injection effect, size for pain, disability, and quality of life were 1.98, 2.02, 1.40, and 1.60, respectively. CONCLUSIONS Triamcinolone/lidocaine ultrasonophoresis demonstrated similar outcomes to injection in reducing pain, improving disability, and enhancing quality of life in patients with acute RCRSP in short time. According to our findings, ultrasonophoresis with triamcinolone/lidocaine cream is as effective as triamcinolone/lidocaine injection and can be proposed as a potential adjunctive treatment for patients with acute RCRSP.
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Affiliation(s)
- Salman Nazary-Moghadam
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopaedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Tehrani
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Reza Kachoei
- Orthopaedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Ali Moradi
- Orthopaedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Ali Zare
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afsaneh Zeinalzadeh
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
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Karanasios S, Baglatzis G, Lignos I, Billis E. Manual Therapy and Exercise Have Similar Outcomes to Corticosteroid Injections in the Management of Patients With Subacromial Pain Syndrome: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e48907. [PMID: 38111394 PMCID: PMC10726085 DOI: 10.7759/cureus.48907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/20/2023] Open
Abstract
Subacromial pain syndrome (SAPS) is the most frequent diagnosis in patients with shoulder pain presenting with persistent pain and significant functional decline. Although exercise and manual therapy (EMT) and corticosteroid injections provide first-line treatment options, evidence for the best management of SAPS remains inconclusive. We aimed to evaluate the effectiveness of EMT compared with corticosteroid injections on disability, recovery rates, and pain in patients with SAPS through a systematic review and meta-analysis approach. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), ScienceDirect, the Cochrane Library, and grey literature databases were searched. Only randomized controlled trials evaluating the effectiveness of EMT alone or as an additive intervention compared to corticosteroid injections were included. Methodological quality was evaluated with the PEDro score and certainty of evidence with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. In total, 8 trials with 946 patients were included. EMT presented no difference in disability compared with corticosteroid injections at very short- (standardized mean difference {SMD}: 0.19; 95%CI: -0.20, 0.58), short- (SMD: -0.16; 95%CI: -0.58, 0.25), mid- (SMD: -0.14; 95%CI: -0.44, 0.16), and long-term (SMD: 0.00; 95%CI: -0.25, 0.25) follow-up. No difference was found between the comparators in self-perceived recovery at very short- (risk ratio: 0.93; 95%CI: 0.71, 1.21) and mid- (risk ratio: 0.98; 95%CI: 0.90, 1.07) follow-up and in pain rating at very short- (SMD: -0.18; 95%CI: -0.73, 0.38), short- (SMD: 0.05; 95%CI: -0.26, 0.37), and long-term (SMD: 0.04; 95%CI: -0.26, 0.34) follow-ups. The addition of corticosteroid injections to EMT provided no better results in shoulder disability compared with EMT (SMD: 0.45; 95%CI: -0.47, 1.37) or corticosteroid injections alone (MD: 2.70; 95%CI: -7.70, 13.10) in the mid-term. Based on very low to moderate certainty of evidence, EMT has similar effects to corticosteroid injections on improving all outcomes in patients with SAPS at all follow-up periods. Based on low certainty of evidence the combination of both interventions does not change the treatment outcome compared with each intervention alone.
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Affiliation(s)
| | | | - Ioannis Lignos
- Department of Physiotherapy, University of Patras, Patras, GRC
| | - Evdokia Billis
- Department of Physiotherapy, University of Patras, Patras, GRC
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3
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Feng S, Li H, Zhong Y, Xie Y, Chen J, Chen Y, Chen S. Functional and Structural Outcomes After Arthroscopic Rotator Cuff Repair With or Without Preoperative Corticosteroid Injections. Am J Sports Med 2023; 51:733-742. [PMID: 36734466 DOI: 10.1177/03635465221145949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Corticosteroid injections (CSIs) are effective in alleviating pain in patients with rotator cuff tears, but controversy still exists regarding their potential adverse effects on clinical outcomes after rotator cuff repair. PURPOSE To compare both the functional and the structural outcomes in patients who underwent arthroscopic rotator cuff repair with or without preoperative CSIs. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective cohort study was carried out among patients who underwent arthroscopic rotator cuff repair for partial- and full-thickness tears between 2015 and 2019. The patients who received preoperative CSIs were included in the CSI group and compared with a group without preoperative CSIs (non-CSI group), matched at a ratio of 1:2 based on tear size, age, and follow-up time. Both functional evaluation and structural assessments using magnetic resonance imaging (MRI) were performed at the final follow-up. Clinical outcomes-including retear rate as the primary outcome; pain; functional scores including the Constant-Murley score, American Shoulder and Elbow Surgeons score, and Fudan University Shoulder Score; range of motion (ROM); tendon integrity; tendon healing type; and cartilage thickness-were compared between the 2 groups with a statistical significance of P < .05 and power of 0.9. RESULTS Thirty-one patients were included in the CSI group, and 62 were included in the non-CSI group. After a mean 3-year follow-up, the 2 groups demonstrated no significant differences in retear rate; visual analog scale for pain; shoulder functional scores; and active ROM including forward flexion, abduction, external rotation, and internal rotation. No significant differences were observed on postoperative MRI scans of the rotator cuff tendon (tendon integrity, healing type, residual tendon attachment area, etc), cartilage thickness, and muscle atrophy. CONCLUSION No significant differences were found at a mean 3-year follow-up in the retear rates, pain, ROM, and glenohumeral structure on postoperative MRI scans after arthroscopic rotator cuff repair with or without preoperative CSIs.
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Affiliation(s)
- Sijia Feng
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Huizhu Li
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuting Zhong
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuxue Xie
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Chen
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuzhou Chen
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyi Chen
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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4
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Efficacy of high-volume vs very low volume corticosteroid subacromial injection in subacromial impingement syndrome: a randomized controlled trial. Sci Rep 2023; 13:2174. [PMID: 36750606 PMCID: PMC9905592 DOI: 10.1038/s41598-023-29449-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
Subacromial corticosteroid injections (SCI) treat shoulder pain from subacromial impingement syndrome (SIS). However, a high-volume corticosteroid injection (HVCI) increases the incidence of local and general complications from lidocaine. This study aimed to compare the results of functional and clinical outcomes between the very low-volume corticosteroid injection (VLVCI) and HVCI including to WORC (Western Ontario Rotator Cuff Index), VAS (Visual Analog Scale), DASH (The disabilities of the arm, shoulder, and hand) and ROM (Range of Motion). A total of 64 patients presenting with SIS were evaluated in two SCI volume in a randomization-controlled trial study. The VAS for pain pre-injection and post-injection at 15 min, was from 5.34 ± 2.44 at before injection to 2.44 ± 1.58 at post injection 15 min in the HVCI group (P < 0.001) and from 5.19 ± 2.33 to 2.84 ± 1.49 in VLVCI group (P < 0.001). Not significant differences at mean difference VAS post-injection 15 min VAS (P = 0.324) and Percentage difference VAS pre-injection and post-injection (P = 0.24). All follow-up timing, there were no significant differences in WORC, DASH and ROM between two groups (P > 0.05). The results revealed the VLVCI is non-inferior to HVCI both of functional outcomes and VAS.
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5
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Effect of the Critical Shoulder Angle on the Efficacy of Ultrasound-Guided Steroid Injection for Subacromial Bursitis. J Pers Med 2022; 12:jpm12111879. [PMID: 36579587 PMCID: PMC9692981 DOI: 10.3390/jpm12111879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/29/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022] Open
Abstract
The critical shoulder angle (CSA) is associated with impingement and rotator cuff lesions, and ultrasound-guided corticosteroid injection is effective for subacromial bursitis. However, because the efficacy of this treatment varies, this study investigated the effect of the CSA on the efficacy of corticosteroid injection in the subacromial space. Patients who received a diagnosis of subacromial bursitis after a clinical physical examination and ultrasound were enrolled prospectively from May 2019 to December 2021. Patients’ baseline variables and CSAs were assessed before intervention. Patients’ shoulder pain and disability index (SPADI), visual analog scale (VAS), and shoulder joint range of motion (ROM) scores were assessed at 2, 6, and 12 weeks after ultrasound-guided corticosteroid injection. All participants were divided into CSA > 38° and CSA ≤ 38° groups. We conducted the intragroup and intergroup comparisons of the variables and performed Pearson analysis to identify potential correlations between the CSA and outcome parameters. A total of 55 patients were enrolled in this study. Of these, 28 were included in the CSA > 38° group and 27 in the CSA ≤ 38° group. The baseline variables of the two groups did not differ. In the intragroup and intergroup comparisons, although VAS, SPADI, and ROM scores improved up to 12 weeks after intervention, no difference was identified between groups. The Pearson analysis revealed a positive correlation (r = 0.30, p = 0.024) between the CSA and VAS scores before the intervention. However, no correlation was found between the CSA and follow-up parameters. The CSA was not associated with the clinical efficacy of ultrasound-guided corticosteroid injection for subacromial bursitis.
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6
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Ziradkar R, Best TM, Quintero D, Paultre K. Nonsteroidal Anti-inflammatory and Corticosteroid Injections for Shoulder Impingement Syndrome: A Systematic Review and Meta-analysis. Sports Health 2022:19417381221108726. [PMID: 35897160 PMCID: PMC10293554 DOI: 10.1177/19417381221108726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT To determine optimal treatment strategies for shoulder impingement syndrome (SIS). OBJECTIVE To compare subacromial nonsteroidal anti-inflammatory injections (SNIs) and subacromial corticosteroid injections (SCIs) on pain relief and functional improvement in individuals with SIS. Second, to perform a cost analysis of the 2 injections. DATA SOURCES MEDLINE, SPORTDiscus, CINAHL, Embase, Web of Science, and SCOPUS databases were searched for randomized controlled trials using several keywords. STUDY SELECTION The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized, and 10 studies comparing changes in pain or function in humans with SIS receiving SNIs or SCIs were included. Quality and risk of bias were assessed using the Consolidated Standards of Reporting Trials (CONSORT) 2010 scale and the Cochrane Collaboration tool. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 1. DATA EXTRACTION Baseline and follow-up scores of the visual analog, Constant-Murley, and University of California Los Angeles shoulder scales were extracted to calculate effect sizes (ESs), represented as Cohen d. Metaregression and publication bias analyses were performed. Procedural and medication costs were extracted from Medicare guidelines. RESULTS A total of 7 high and 3 good quality studies were included, with a mean score of 21.1. Only 1 study had a high risk of bias. The meta-analyses produced pooled ESs of 0.05 (P = 0.83), 0.12 (P = 0.71), and 0.07 (P = 0.79) for each scale, respectively, with CIs crossing 0. Procedural costs were equal between groups, whereas ketorolac was the least costly medication ($0.47). There was no significant difference in side effects between the 2 injections. CONCLUSION SNIs are as effective as SCIs for short-term pain relief and improving function in patients with subacromial impingement syndrome. In addition, they are less expensive and cause no major difference in complications, providing a viable, cost-effective alternative for injection therapy in patients with SIS.
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Affiliation(s)
- Rhushi Ziradkar
- Department of Orthopedics and Family Medicine, University of Miami Sports Medicine Institute, Coral Gables, Florida
| | - Thomas M Best
- Department of Orthopedics and Family Medicine, University of Miami Sports Medicine Institute, Coral Gables, Florida
| | - Daniel Quintero
- University of Miami Miller School of Medicine, Miami, Florida
| | - Kristopher Paultre
- Department of Orthopedics and Family Medicine, University of Miami Sports Medicine Institute, Coral Gables, Florida
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7
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Catapano M, Ahmed M, Breslow RG, Borg-Stein J. The aging athlete. PM R 2022; 14:643-651. [PMID: 35441493 DOI: 10.1002/pmrj.12814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/09/2022]
Abstract
Aging athletes, those 60 years and older, are a growing population of mature, active individuals who value sports and exercise participation throughout their lifespan. Although recommendations for younger and masters athletes have been extrapolated to this population, there remains a paucity of specific guidelines, treatment algorithms, and considerations for aging athletes. The benefits of living an active lifestyle must be weighed against the risks for unique cardiovascular, metabolic, and musculoskeletal injuries requiring diagnostic and therapeutic interventions. In this article, we review the unique cardiovascular and muscular physiology of aging athletes and how it influences the risk of specific medical conditions. We also discuss general prevention and treatment strategies. Finally, we identify areas of future research priorities and emerging treatments.
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Affiliation(s)
- Michael Catapano
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA.,Division of Sports Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marwa Ahmed
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA.,Division of Sports Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Joanne Borg-Stein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA.,Division of Sports Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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8
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Babatunde OO, Ensor J, Littlewood C, Chesterton L, Jordan JL, Corp N, Wynne-Jones G, Roddy E, Foster NE, van der Windt DA. Comparative effectiveness of treatment options for subacromial shoulder conditions: a systematic review and network meta-analysis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211037530. [PMID: 34527083 PMCID: PMC8435933 DOI: 10.1177/1759720x211037530] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 07/16/2021] [Indexed: 12/21/2022] Open
Abstract
Background: There are currently many treatment options for patients with subacromial shoulder conditions (SSCs). Clinical decision-making regarding the best treatment option is often difficult. This study aims to evaluate the comparative effectiveness of treatment options for relieving pain and improving function in patients with SSCs. Methods: Eight databases [including MEDLINE, Embase, CINAHL, AMED, PEDro, Cochrane Database of Systematic Reviews and World Health Organization (WHO) International Clinical Trials Registry] were searched from inception until April 2020. Randomised clinical/controlled trials of adult patients investigating the effects of nonsurgical (e.g. corticosteroid injections, therapeutic exercise, shockwave therapy) and surgical treatment for SSCs, compared with each other, placebo, usual care or no treatment, were retrieved. Pairs of reviewers screened studies independently, quality appraised eligible studies using the Cochrane risk of bias tool, extracted and checked data for accuracy. Primary outcomes were pain and disability in the short term (⩽3 months) and long term (⩾6 months). Direct and indirect evidence of treatment effectiveness was synthesised using random-effects network meta-analysis. Results: The review identified 177 eligible trials. Summary estimates (based on 99 trials providing suitable data, 6764 patients, 20 treatment options) showed small to moderate effects for several treatments, but no significant differences on pain or function between many active treatment comparisons. The primary analysis indicated that exercise and laser therapy may provide comparative benefit in terms of both pain and function at different follow-up time-points, with larger effects found for laser in the short term at 2–6 weeks, although direct evidence was provided by one trial only, and for exercise in the longer term [standardised mean difference (SMD) 0.39, 95% confidence interval (CI) 0.18, 0.59 at 3–6 months] compared with control. Sensitivity analyses excluding studies at increased risk of bias confirmed only the comparative effects of exercise as being robust for both pain and function up until 3-month follow-up. Conclusion: Current evidence shows small to moderate effect sizes for most treatment options for SSCs. Six treatments had a high probability of being most effective, in the short term, for pain and function [acupuncture, manual therapy, exercise, exercise plus manual therapy, laser therapy and Microcurrent (MENS) (TENS)], but with low certainty for most treatment options. After accounting for risk of bias, there is evidence of moderate certainty for the comparative effects of exercise on function in patients with SSCs. Future large, high-quality pragmatic randomised trials or meta-analyses are needed to better understand whether specific subgroups of patients respond better to some treatments than others.
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Affiliation(s)
- Opeyemi O Babatunde
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele ST5 5BG, Staffordshire, UK
| | - Joie Ensor
- School of Medicine, Keele University, Keele, UK
| | | | | | | | - Nadia Corp
- School of Medicine, Keele University, Keele, UK
| | | | - Edward Roddy
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Danielle A van der Windt
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
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Deng G, Gofeld M, Reid JN, Welk B, Agur AM, Loh E. A Retrospective Cohort Study of Healthcare Utilization Associated with Paravertebral Blocks for Chronic Pain Management in Ontario. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2021; 5:130-138. [PMID: 34263095 PMCID: PMC8253135 DOI: 10.1080/24740527.2021.1929883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Injections, particularly paravertebral blocks (PVBs), are frequently performed procedures in Ontario, Canada, for the management of chronic pain, despite limited evidence and risk of complications. Aim: This study examines usage patterns of PVBs to evaluate their effects on healthcare utilization and opioid prescribing. Methods: A retrospective cohort study in Ontario using administrative data. Ontario residents receiving their initial PVBs between July 1, 2013 and March 31, 2018 were included. Changes in use of other interventions, physician visits, and opioids were compared to the 12-month periods before and after index PVBs. Data use was authorized under section 45 of Ontario's Personal Health Information Protection Act. Results: 47,723 patients received their initial PVBs in the study period. The rate of index PVBs increased from 1.61 per 10,000 population (2013) to 2.26 per 10,000 (2018). Initial PVBs were performed most commonly by family physicians (N = 25,042), followed by anesthesiologists (N = 14,195). 23,386 patients (49%) received 1 to 9 repeat PVBs in the 12 months after index PVB; 12,474 patients (26.15%) received 10 or more. Use of other nonimage guided interventional pain procedures per patient (mean±SD) increased from 2.19 ± 9.35 to 31.68 ± 52.26 in the year before and after index PVB. Relevant physician visits per patient (mean±SD) also increased from 2.92 ± 3.61 to 9.64 ± 11.77. Mean opioid dosing did not change significantly between the year before and the year after index PVB. Conclusion: PVBs are associated with increases in healthcare utilization and no change in opioid use patterns.
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Affiliation(s)
| | | | | | - Blayne Welk
- ICES, Ontario, Canada.,Department of Surgery, Western University, London, Ontario, Canada
| | - Anne Mr Agur
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Eldon Loh
- Department of Physical Medicine and Rehabilitation, Western University, London, Ontario, Canada.,Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada
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10
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Hsieh LF, Lin YJ, Hsu WC, Kuo YC, Liu YC, Chiang YP, Wang CP. Comparison of the corticosteroid injection and hyaluronate in the treatment of chronic subacromial bursitis: A randomized controlled trial. Clin Rehabil 2021; 35:1305-1316. [PMID: 33858205 DOI: 10.1177/02692155211007799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyse the effectiveness of corticosteroid (CS) and hyaluronic acid (HA) subacromial - subdeltoid (SASD) injection compared with normal saline (NS) in patients with chronic subacromial bursitis (CSB). DESIGN A prospective three-arm double-blinded randomised controlled trial. SETTING Rehabilitation department of two teaching hospitals. SUBJECTS Patients with CSB (N = 186) divided into CS (N = 68), HA (N = 60), and NS (N = 58) groups. INTERVENTIONS Three SASD injections under ultrasound guidance: group A, 20 mg of triamcinolone; group B, 2.5 mL of HA; and group C, 2.5 mL of NS. OUTCOME MEASURES The primary outcome measures were the pain visual analogue scale (VAS) score at eight weeks. The secondary outcomes were scores on the Shoulder Pain and Disability Index (SPADI) and Shoulder Disability Questionnaire. RESULTS At eight weeks, the pain VAS scores during activity were 2.56 ± 2.29, 3.65 ± 2.50, and 4.71 ± 2.83 in the CS, HA, and NS groups, respectively (CS vs NS, P < 0.001; HA vs NS, P = 0.013; CS vs HA, P = 0.010). SPADI scores were 40.83 ± 21.75, 36.92 ± 22.78, and 33.35 ± 23.38 in the CS, HA, and NS groups, respectively (CS vs NS, P < 0.001; HA vs NS, P = 0.197; CS vs HA, P = 0.004). CONCLUSION Ultrasound-guided corticosteroid injection into the subacromial - subdeltoid bursa was proven to be effective and superior to hyaluronic acid and normal saline injection for treating CSB. Hyaluronic acid injection was only marginally more effective than normal saline injection.Trial Registration: ClinicalTrials.gov: NCT02702206.
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Affiliation(s)
- Lin-Fen Hsieh
- Department of Physical Medicine & Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei.,School of Medicine, Fu Jen Catholic University, New Taipei City
| | - Yi-Jia Lin
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei
| | - Wei-Chun Hsu
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei
| | - Ying-Chen Kuo
- Department of Physical Medicine & Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
| | - Yu-Chia Liu
- Department of Physical Medicine & Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
| | - Yi-Pin Chiang
- Department of Rehabilitation Medicine, MacKay Memorial Hospital, Taipei.,Mackay Medical College, New Taipei City
| | - Chun-Ping Wang
- Department of Physical Medicine & Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
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11
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Nazari G, MacDermid JC, Bobos P. Conservative versus Surgical Interventions for Shoulder Impingement: An Overview of Systematic Reviews of Randomized Controlled Trials. Physiother Can 2020; 72:282-297. [PMID: 35110797 DOI: 10.3138/ptc-2018-0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Numerous systematic reviews (SRs) of randomized controlled trials (RCTs) have emerged that investigate the effectiveness of conservative (supervised exercises) versus surgical (arthroscopic subacromial decompression) interventions for patients with shoulder impingement; however, there are disparities in the quality of the evidence synthesized. The purpose of this study was to conduct an overview of SRs of RCTs to critically appraise the evidence and establish the current state of effectiveness of conservative versus surgical interventions on clinical outcomes among patients with shoulder impingement. Method: The MEDLINE, EMBASE, CINAHL, and PubMed electronic databases were searched for January 2008 to September 2018, and we found SRs of RCTs of patients with shoulder impingement, subacromial pain syndrome, or subacromial impingement syndrome who had received conservative versus surgical interventions to improve outcomes. Two authors extracted the data, and two independent review authors assessed the risk of bias and quality. Results: A total of 15 SRs were identified. One was rated as high quality, 7 as moderate quality, 5 as low quality, and 2 as critically low quality. The results were in line with one another, indicating that no differences in outcomes existed between conservative and surgical interventions among patients with shoulder impingement. Conclusion: There were no clinically important or statistically significant differences in outcomes between conservative versus surgical interventions among patients with subacromial impingement syndrome. To enhance clinical outcomes in this patient population, shoulder-specific exercises that aim to improve muscle strength and flexibility must be considered as the first line of conservative treatment.
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Affiliation(s)
- Goris Nazari
- School of Physical Therapy, Faculty of Health Sciences.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University
| | - Joy C MacDermid
- School of Physical Therapy, Faculty of Health Sciences.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ont
| | - Pavlos Bobos
- School of Physical Therapy, Faculty of Health Sciences.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University
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12
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Goyal T, Paul S, Sethy SS, Choudhury AK. Outcomes of ketorolac versus depomedrol infiltrations for subacromial impingement syndrome: a randomized controlled trial. Musculoskelet Surg 2020; 106:29-34. [PMID: 32445077 DOI: 10.1007/s12306-020-00667-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Local subacromial infiltration with steroids is a common method of treatment of subacromial impingement syndrome. However, the use of steroids has concerns like tendon rupture, articular cartilage changes and infections. Local NSAIDs infiltration has recently been tried in literature. This study compares the effect of subacromial injections of ketorolac with steroids. METHODS A randomized controlled study was planned with 35 patients in each group. Patients in group-1 were infiltrated with subacromial ketorolac (60 mg with 2% lignocaine) and in group-2 with a steroid (methylprednisolone-40 mg with 2% lignocaine). A similar rehabilitation protocol was followed, and clinical outcomes were analyzed using visual analog scale (VAS) for pain and shoulder pain and disability score (SPADI) and range of motion at one-month and three-months follow-up. RESULTS Total data of 67 patients were analyzed, as three patients were lost to follow-up. In group 1, mean VAS improved from 7.9 [Formula: see text] 0.95 to 3.19 [Formula: see text] 0.81 (p < 0.001) and SPADI improved from 61.41 [Formula: see text] 11.86 to 28.91 [Formula: see text] 9.06 (p < 0.001) at three months, respectively. In group 2, mean VAS improved from 8.05 [Formula: see text] 0.94 to 2.9 [Formula: see text] 0.64 (p < 0.001) and SPADI improved from 63.45 [Formula: see text] 9.64 to 25.32 [Formula: see text] 6.87 (p < 0.001) at three months, respectively. However, there were no differences in functional outcomes between the groups (p = 0.21 for VAS, p = 0.16 for SPADI). CONCLUSION Subacromial ketorolac infiltration has an equivalent outcome as that of steroid infiltration. Ketorolac could be considered as a reasonable alternative to steroids in cases where it is contraindicated.
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Affiliation(s)
- T Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, AIIMS, Virbhadra Marg, Rishikesh, Uttarakhand, 249201, India
| | - S Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, AIIMS, Virbhadra Marg, Rishikesh, Uttarakhand, 249201, India
| | - S S Sethy
- Department of Orthopaedics, All India Institute of Medical Sciences, AIIMS, Virbhadra Marg, Rishikesh, Uttarakhand, 249201, India.
| | - A K Choudhury
- Department of Orthopaedics, All India Institute of Medical Sciences, AIIMS, Virbhadra Marg, Rishikesh, Uttarakhand, 249201, India
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13
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An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain. J Orthop Sports Phys Ther 2020; 50:131-141. [PMID: 31726927 DOI: 10.2519/jospt.2020.8498] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To update a systematic review published in 2013 that focused on evaluating the effectiveness of interventions within the scope of physical therapy, including exercise, manual therapy, electrotherapy, and combined or multimodal approaches to managing shoulder pain. DESIGN Umbrella review. LITERATURE SEARCH An electronic search of PubMed, Web of Science, and CINAHL was undertaken. Methodological quality was assessed using the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) checklist for systematic reviews. STUDY SELECTION CRITERIA Nonsurgical treatments for subacromial shoulder pain. DATA SYNTHESIS Sixteen systematic reviews were retrieved. Results were summarized qualitatively. RESULTS A strong recommendation can be made for exercise therapy as the first-line treatment to improve pain, mobility, and function in patients with subacromial shoulder pain. Manual therapy may be integrated, with a strong recommendation, as additional therapy. There was moderate evidence of no effect for other commonly prescribed interventions, such as laser therapy, extracorporeal shockwave therapy, pulsed electromagnetic energy, and ultrasound. CONCLUSION There is a growing body of evidence to support exercise therapy as an intervention for subacromial shoulder pain. Ongoing research is required to provide guidance on exercise type, dose, duration, and expected outcomes. A strong recommendation may be made regarding the inclusion of manual therapy in the initial treatment phase. J Orthop Sports Phys Ther 2020;50(3):131-141. Epub 15 Nov 2019. doi:10.2519/jospt.2020.8498.
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Zamzam M, El Yasaki A, El Garabawy N, El Ghandour LEE. Shockwave therapy versus local steroid injection in chronic supraspinatus tendinopathy. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2019. [DOI: 10.4103/err.err_16_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Taheri P, Dehghan F, Mousavi S, Solouki R. Comparison of Subacromial Ketorolac Injection versus Corticosteroid Injection in the Treatment of Shoulder Impingement Syndrome. J Res Pharm Pract 2018; 6:223-227. [PMID: 29417082 PMCID: PMC5787908 DOI: 10.4103/jrpp.jrpp_17_57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: Subacromial impingement syndrome is the most common cause of shoulder pain and restriction in range of motion in the world. The aim of this study was to compare the efficacy of subacromial injection of ketorolac with the injection of corticosteroid for the treatment of subacromial impingement syndrome. Methods: A total of forty patients were randomly allocated into two groups. Group A received 40 mg of methylprednisolone and Group B received 60 mg of ketorolac as a subacromial injection along with lidocaine. Each patient was evaluated in terms of visual analog scale (VAS) for evaluating pain and Constant's score for function evaluation (pain, activity level, and range of motion with standard goniometry). The patients were re-examined 1 and 3 months after intervention. All the patients educated for simple home exercise. Findings: At 1 and 3 months of follow-up, both treatment arms resulted in an increased range of motion and decreased pain. The difference between the groups was not statistically significant (P > 0.05). In ketorolac group, mean pre- and post-treatment (at 12 weeks) VAS scores were 8.6 (range, 3–9) and 4.5 (range 2–4), respectively. In steroid group, mean pre- and post-treatment (at 12 weeks) VAS scores were 8.3 (range, 3–10) and 3.9 (range, 0–7), respectively. The difference was statistically significant within groups at baseline and 1 (P < 0.001) and 3 (P < 0.001) months after the injection. Conclusion: Subacromial injection of ketorolac has an equivalent outcome to subacromial injection of corticosteroid. The use of ketorolac injections can substantially decrease the pain and increase the range of motion of the shoulder and could be a reasonable alternative in case of corticosteroid contraindications.
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Affiliation(s)
- Parisa Taheri
- Department of Physical Medicine and Rehabilitation, Alzahra Training and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farnaz Dehghan
- Department of Physical Medicine and Rehabilitation, Alzahra Training and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahar Mousavi
- Department of Physical Medicine and Rehabilitation, Alzahra Training and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Solouki
- Departement of Internal Medicine, Poursina Hakim Research Institute for Health Care Development, Isfahan, Iran
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16
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Short-term outcomes of subacromial injection of combined corticosteroid with low-volume compared to high-volume local anesthetic for rotator cuff impingement syndrome: a randomized controlled non-inferiority trial. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1079-1087. [DOI: 10.1007/s00590-018-2149-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/31/2018] [Indexed: 02/07/2023]
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Cook T, Minns Lowe C, Maybury M, Lewis JS. Are corticosteroid injections more beneficial than anaesthetic injections alone in the management of rotator cuff-related shoulder pain? A systematic review. Br J Sports Med 2018; 52:497-504. [DOI: 10.1136/bjsports-2016-097444] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 11/04/2022]
Abstract
ObjectiveTo compare the effectiveness of corticosteroid injections to local anaesthetic injections in the management of rotator cuff-related shoulder pain (RCRSP).DesignSystematic review with best evidence synthesis.Data sourcesThe Cochrane, PubMed, CINAHL Plus, PEDro and EMBASE electronic databases were searched (inception until 8 June 2017). Reference lists of included articles were also hand searched.Eligibility criteriaTwo reviewers independently evaluated eligibility. Randomised controlled trials (RCTs) were included if they compared subacromial injections of corticosteroid with anaesthetic injections. Two reviewers independently extracted data regarding short-term, midterm and long-term outcomes for pain, self-reported function, range of motion and patient-perceived improvement.ResultsThirteen RCTs (n=1013) were included. Four trials (n=475) were judged as being at low risk of bias. Three studies of low risk of bias favoured the use of corticosteroid over anaesthetic-only injections in the short term (up to 8 weeks). There was strong evidence of no significant difference between injection types in midterm outcomes (12–26 weeks). There was limited evidence of no significant difference between injection types in long-term outcomes.ConclusionCorticosteroid injections may have a short-term benefit (up to 8 weeks) over local anaesthetic injections alone in the management of RCRSP. Beyond 8 weeks, there was no evidence to suggest a benefit of corticosteroid over local anaesthetic injections.Trial registration numberPROSPERO CRD42016033161.
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18
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Comparative outcomes of combined corticosteroid with low volume compared to high volume of local anesthetic in subacromial injection for impingement syndrome: systematic review and meta-analysis of RCTs. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:397-407. [PMID: 29027006 DOI: 10.1007/s00590-017-2056-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 10/04/2017] [Indexed: 12/19/2022]
Abstract
Subacromial impingement syndrome (SIS) is one of the most frequent pathologies of the shoulder, which may cause serious restriction of daily activities and lifestyle changes. Corticosteroid injection (CI) into the subacromial space is a palliative treatment option. Currently, there have been no studies that compare between the different volumes of CI injection. We have conducted a systematic review and meta-analysis to answer our specific study questions: Are high volume (< 5 ml) better than low volume (≥ 5 ml) of CI injection with respect to pain reduction? This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Relevant studies were identified from Medline and Scopus from inception to May 11, 2017 that reported American shoulder and elbow surgeons (ASES) function score, pain visual analog score (VAS), and postoperative complications of either group. Fifteen studies were included for the analysis of high volume (more than or equal 5 ml), and 5 studies were included for analysis of low volume (less than 5 ml). Overall, there were 1101 patients (732 in the high-volume group and 369 in the low-volume group). A pooling of mean VAS and ASES function score was (N = 557) 2.02 (95% CI 1.52, 2.53), (N = 190) 82.59 (95% CI 76.92, 88.27) in high-volume group and (N = 179) 2.60 (95% CI 1.94, 3.26), (N = 95) 84.65 (95% CI 81.64, 86.82) in low-volume group, respectively. The unstandardized mean difference of ASES and VAS of high volume was - 0.58 (95% confidence interval (CI): - 1.38, 0.22) and - 2.06 (95% CI - 8.35, 4.23) scores lower than low-volume CI in SIS patients, but without statistical significance. A total of 11 studies in the high-volume group and 4 studies in the low-volume group reported adverse effects. The total complication rate per patient was 6.2% (2.3, 10.1%) in the high-volume group and 11.7% (0.3, 12%) in the low-volume group (p = 0.091). No significant differences were noted for complications. In subacromial impingement syndrome, the corticosteroid injection had acceptable pain and functional outcomes. Higher volume had a lower ASES, VAS, and risk of having complication when compared to lower volume. However, there are no statistically significant differences between groups. Larger, randomized noninferiority or equivalent trial studies are needed to confirm these findings as the current literature is still insufficient. Level of evidence I.
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19
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Carpal Tunnel Syndrome: Effectiveness of Physical Therapy and Electrophysical Modalities. An Updated Systematic Review of Randomized Controlled Trials. Arch Phys Med Rehabil 2017; 99:1623-1634.e23. [PMID: 28942118 DOI: 10.1016/j.apmr.2017.08.482] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/17/2017] [Accepted: 08/22/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To review scientific literature studying the effectiveness of physical therapy and electrophysical modalities for carpal tunnel syndrome (CTS). DATA SOURCES The Cochrane Library, PubMed, Embase, CINAHL, and Physiotherapy Evidence Database. STUDY SELECTION Two reviewers independently applied the inclusion criteria to select potential eligible studies. DATA EXTRACTION Two reviewers independently extracted the data and assessed the methodologic quality using the Cochrane Risk of Bias Tool. DATA SYNTHESIS A best-evidence synthesis was performed to summarize the results of the included studies (2 reviews and 22 randomized controlled trials [RCTs]). For physical therapy, moderate evidence was found for myofascial massage therapy versus ischemic compression on latent, or active, trigger points or low-level laser therapy in the short term. For several electrophysical modalities, moderate evidence was found in the short term (ultrasound vs placebo, ultrasound as single intervention vs other nonsurgical interventions, ultrasound vs corticosteroid injection plus a neutral wrist splint, local microwave hyperthermia vs placebo, iontophoresis vs phonophoresis, pulsed radiofrequency added to wrist splint, continuous vs pulsed vs placebo shortwave diathermy, and interferential current vs transcutaneous electrical nerve stimulation vs a night-only wrist splint). In the midterm, moderate evidence was found in favor of radial extracorporeal shockwave therapy (ESWT) added to a neutral wrist splint, in favor of ESWT versus ultrasound, or cryo-ultrasound, and in favor of ultrasound versus placebo. For all other interventions studied, only limited, conflicting, or no evidence was found. No RCTs investigating the long-term effects of physical therapy and electrophysical modalities were found. Because of heterogeneity in the treatment parameters used in the included RCTs, optimal treatment parameters could not be identified. CONCLUSIONS Moderate evidence was found for several physical therapy and electrophysical modalities for CTS in the short term and midterm. Future studies should concentrate on long-term effects and which treatment parameters of physical therapy and electrophysical modalities are most effective for CTS.
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20
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Dørum IH, Heir S, Solheim E, Magnussen LH. Implementation of conservative treatment prior to arthroscopic subacromial decompression of the shoulder. Knee Surg Sports Traumatol Arthrosc 2017; 25:2060-2066. [PMID: 27043344 DOI: 10.1007/s00167-016-4091-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 03/14/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of the study was to investigate to what extent patients undergo evidence-based conservative treatment prior to arthroscopic subacromial decompression of the shoulder. METHODS One hundred and twenty patients (65 women, 55 men, median age 53.5 years (range 28-70), referred to arthroscopic subacromial decompression at two hospitals in Norway, were consecutively included in the study. The patients completed a self-administered questionnaire including questions concerning the quantity and nature of preoperative treatment as well as the QuickDASH score. They were specifically asked for the extent of evidence-based conservative treatment, i.e. the combination of strengthening and stretching exercises at a minimum weekly amount and total duration. RESULTS One hundred and nine patients (91 %) reported having received conservative treatment guided by a physiotherapist preoperatively. The patients' main reasons for not seeing a physiotherapist were lack of trust in the treatment (N = 7) and the assumption that surgery would provide faster relief of symptoms (N = 6). Of those visiting a physiotherapist, 80 % received specific shoulder exercises. Forty-five per cent did both strengthening and stretching exercises, only 32 % did the exercises three times per week more than 2 months, and 24 % did more than 3 months as recommended. Seventy-six per cent of the patients who discontinued the prescribed exercise programme did this due to increasing pain. CONCLUSIONS Most of the patients in the current study reported having visited a physiotherapist before surgery. However, less than half of them underwent evidence-based exercise treatment, and increased pain was the main reason for not completing the prescribed exercise treatment. The results might be of clinical relevance for physiotherapists treating patients with SAPS, but also for orthopaedic surgeons doing preoperative evaluations. LEVEL OF EVIDENCE Case series, IV.
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Affiliation(s)
- Ingrid Husdal Dørum
- Department of Occupational therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
| | - Stig Heir
- Martina Hansens Hospital, Baerum, Norway
| | - Eirik Solheim
- Aleris Nesttun, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Liv Heide Magnussen
- Department of Occupational therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway. .,Department of Global Public Health and Primary Care, Physiotherapy Research Group, University of Bergen, Bergen, Norway.
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21
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Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Foster NE, Protheroe J. Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS One 2017; 12:e0178621. [PMID: 28640822 PMCID: PMC5480856 DOI: 10.1371/journal.pone.0178621] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 05/16/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND & AIMS Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care. METHODS A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach. RESULTS Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options. CONCLUSION This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most promising treatments is needed.
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Affiliation(s)
- Opeyemi O. Babatunde
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Joanne L. Jordan
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Danielle A. Van der Windt
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Jonathan C. Hill
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Nadine E. Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Joanne Protheroe
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
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Franke TP, Koes BW, Geelen SJ, Huisstede BM. Do Patients With Carpal Tunnel Syndrome Benefit From Low-Level Laser Therapy? A Systematic Review of Randomized Controlled Trials. Arch Phys Med Rehabil 2017. [PMID: 28629992 DOI: 10.1016/j.apmr.2017.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To systematically review the literature on the effectiveness of low-level laser therapy for patients with carpal tunnel syndrome. DATA SOURCES The Cochrane Library, PubMed, Embase, CINAHL, and Physiotherapy Evidence Database were searched for relevant systematic reviews and randomized controlled trials (RCTs) up to April 8, 2016. STUDY SELECTION Two reviewers independently applied the inclusion criteria to select potential studies. DATA EXTRACTION Two reviewers independently extracted the data and assessed the methodologic quality. DATA SYNTHESIS A best-evidence synthesis was performed to summarize the results of the 2 systematic reviews and 17 RCTs that were included. Strong evidence was found for the effectiveness of low-level laser therapy compared with placebo treatment in the very short term (0 to ≤5wk). After 5 weeks, the positive effects of low-level laser therapy on pain, function, or recovery diminished over time (moderate and conflicting evidence were found at 7- and 12-wk follow-up, respectively). CONCLUSIONS In the very short term, low-level laser therapy is more effective as a single intervention than placebo low-level laser therapy in patients with carpal tunnel syndrome, after which the positive effects of low-level laser therapy tend to subside. Evidence in the midterm and long term is sparse.
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Affiliation(s)
- Thierry P Franke
- Department of Rehabilitation, Physical Therapy Science & Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sven J Geelen
- Department of Rehabilitation, Physical Therapy Science & Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bionka M Huisstede
- Department of Rehabilitation, Physical Therapy Science & Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, The Netherlands.
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23
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Steuri R, Sattelmayer M, Elsig S, Kolly C, Tal A, Taeymans J, Hilfiker R. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br J Sports Med 2017. [PMID: 28630217 PMCID: PMC5574390 DOI: 10.1136/bjsports-2016-096515] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate the effectiveness of conservative interventions for pain, function and range of motion in adults with shoulder impingement. DESIGN Systematic review and meta-analysis of randomised trials. DATA SOURCES Medline, CENTRAL, CINAHL, Embase and PEDro were searched from inception to January 2017. STUDY SELECTION CRITERIA Randomised controlled trials including participants with shoulder impingement and evaluating at least one conservative intervention against sham or other treatments. RESULTS For pain, exercise was superior to non-exercise control interventions (standardised mean difference (SMD) -0.94, 95% CI -1.69 to -0.19). Specific exercises were superior to generic exercises (SMD -0.65, 95% CI -0.99 to -0.32). Corticosteroid injections were superior to no treatment (SMD -0.65, 95% CI -1.04 to -0.26), and ultrasound guided injections were superior to non-guided injections (SMD -0.51, 95% CI -0.89 to -0.13). Nonsteroidal anti-inflammatory drugs (NSAIDS) had a small to moderate SMD of -0.29 (95% CI -0.53 to -0.05) compared with placebo. Manual therapy was superior to placebo (SMD -0.35, 95% CI -0.69 to -0.01). When combined with exercise, manual therapy was superior to exercise alone, but only at the shortest follow-up (SMD -0.32, 95% CI -0.62 to -0.01). Laser was superior to sham laser (SMD -0.88, 95% CI -1.48 to -0.27). Extracorporeal shockwave therapy (ECSWT) was superior to sham (-0.39, 95% CI -0.78 to -0.01) and tape was superior to sham (-0.64, 95% CI -1.16 to -0.12), with small to moderate SMDs. CONCLUSION Although there was only very low quality evidence, exercise should be considered for patients with shoulder impingement symptoms and tape, ECSWT, laser or manual therapy might be added. NSAIDS and corticosteroids are superior to placebo, but it is unclear how these treatments compare to exercise.
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Affiliation(s)
- Ruedi Steuri
- Department of Health, Bern University of Applied Sciences, Berne, Switzerland.,Department of Physiotherapy, University of Applied Sciences Western Switzerland, Leukerbad, Switzerland
| | - Martin Sattelmayer
- Department of Physiotherapy, University of Applied Sciences Western Switzerland, Leukerbad, Switzerland.,School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland Valais, Leukerbad, Switzerland
| | - Simone Elsig
- Department of Physiotherapy, University of Applied Sciences Western Switzerland, Leukerbad, Switzerland.,School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland Valais, Leukerbad, Switzerland
| | - Chloé Kolly
- Department of Physiotherapy, University of Applied Sciences Western Switzerland, Leukerbad, Switzerland.,School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland Valais, Leukerbad, Switzerland
| | - Amir Tal
- Department of Health, Bern University of Applied Sciences, Berne, Switzerland
| | - Jan Taeymans
- Department of Health, Bern University of Applied Sciences, Berne, Switzerland.,Faculty of Sport and Rehabilitation Science, Vrije Universiteit Brussel, Brussels, Belgium
| | - Roger Hilfiker
- Department of Physiotherapy, University of Applied Sciences Western Switzerland, Leukerbad, Switzerland.,School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland Valais, Leukerbad, Switzerland
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24
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Chang KV, Wu WT, Han DS, Özçakar L. Static and Dynamic Shoulder Imaging to Predict Initial Effectiveness and Recurrence After Ultrasound-Guided Subacromial Corticosteroid Injections. Arch Phys Med Rehabil 2017; 98:1984-1994. [PMID: 28245972 DOI: 10.1016/j.apmr.2017.01.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/22/2017] [Accepted: 01/26/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore factors contributing to initial effectiveness and recurrence after ultrasound (US)-guided subacromial corticosteroid injections by assessing clinical measurements and static and dynamic shoulder US images. DESIGN Retrospective cohort study. SETTING Rehabilitation outpatient clinic. PARTICIPANTS Adults with shoulder pain referred for injection therapy (N=164). INTERVENTION US-guided subacromial corticosteroid injection. MAIN OUTCOME MEASURES The association of initial effectiveness (defined as >50% decrease in any of the 3 pain subdomains after the first injection) and recurrent shoulder pain that required repeated intervention with record-based clinical measurements and static/dynamic shoulder US. RESULTS This study included 164 patients, 106 of whom were responsive to a first injection. Among the 106 participants, 42 received a second injection because of recurrent shoulder pain. By using the multivariate logistic regression analysis, initial effectiveness was positively associated with right handedness, grade 2 subacromial impingement during the dynamic US examination, and bicipital groove tenderness. However, these patients had a negative association with subdeltoid bursitis, grade 3 subacromial impingement, and shoulder stiffness. Subdeltoid bursitis and a positive painful arc test were predictors of recurrent shoulder pain that necessitated a repeated injection in the Cox proportional hazards model. CONCLUSIONS The initial effectiveness and recurrence after US-guided subacromial corticosteroid injection were associated with certain clinical measurements and static and dynamic shoulder US, which should be carefully evaluated (and can be used) to guide the best treatment outcomes.
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Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Burger M, Africa C, Droomer K, Norman A, Pheiffe C, Gericke A, Samsodien A, Miszewski N. Effect of corticosteroid injections versus physiotherapy on pain, shoulder range of motion and shoulder function in patients with subacromial impingement syndrome: A systematic review and meta-analysis. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2016; 72:318. [PMID: 30135893 PMCID: PMC6093128 DOI: 10.4102/sajp.v72i1.318] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/12/2016] [Indexed: 11/18/2022] Open
Abstract
Background Subacromial impingement syndrome (SIS) is one of the most common causes of shoulder pain. Limited research has been conducted into the efficacy of corticosteroid injections (CSIs) compared to physiotherapy in the management of SIS. Objective To critically appraise and establish the best available evidence for the effectiveness of CSI in comparison with physiotherapy for the management of pain, shoulder range of motion (ROM) and shoulder function in patients with SIS. Methodology Seven databases were searched from inception to February 2016, namely PubMed, Science Direct, EBSCO Host: SPORTDiscus, EBSCO Host: CINAHL, Cochrane, Scopus and PEDro. The main search terms were shoulder impingement syndrome and/or subacromial impingement syndrome, corticosteroid injections and/or steroid injections, physical therapy and/or physiotherapy. Only randomised controlled trials (RCTs) were considered for inclusion. The articles were appraised according to the PEDro scale. The Revman© Review Manager Software was used to combine the results of shoulder function and the data were illustrated in forest plots. Results The PEDro scores of the three RCTs that qualified for this review ranged from 7 to 8/10. There is Level II evidence suggesting that besides a significant improvement in shoulder function in favour of CSI at 6–7 weeks follow-up (p < 0.0001), no evidence was found for the superiority of CSIs compared with physiotherapy for pain, ROM and shoulder function in the short- (1–3 months), mid- (6 months) and long term (12 months). Conclusion In patients with SIS only a short term significant improvement in shoulder function was found in favour of CSIs.
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Affiliation(s)
- Marlette Burger
- Physiotherapy Division, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Carly Africa
- Physiotherapy Division, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Kara Droomer
- Physiotherapy Division, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Alexa Norman
- Physiotherapy Division, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Chloé Pheiffe
- Physiotherapy Division, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Anrich Gericke
- Physiotherapy Division, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Adeeb Samsodien
- Physiotherapy Division, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Natasha Miszewski
- Physiotherapy Division, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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Aksakal M, Ermutlu C, Özkaya G, Özkan Y. Lornoxicam injection is inferior to betamethasone in the treatment of subacromial impingement syndrome. DER ORTHOPADE 2016; 46:179-185. [DOI: 10.1007/s00132-016-3302-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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27
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Oliva F, Piccirilli E, Bossa M, Via AG, Colombo A, Chillemi C, Gasparre G, Pellicciari L, Franceschetti E, Rugiero C, Scialdoni A, Vittadini F, Brancaccio P, Creta D, Buono AD, Garofalo R, Franceschi F, Frizziero A, Mahmoud A, Merolla G, Nicoletti S, Spoliti M, Osti L, Padulo J, Portinaro N, Tajana G, Castagna A, Foti C, Masiero S, Porcellini G, Tarantino U, Maffulli N. I.S.Mu.L.T - Rotator Cuff Tears Guidelines. Muscles Ligaments Tendons J 2016; 5:227-63. [PMID: 26958532 DOI: 10.11138/mltj/2015.5.4.227] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources.
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Affiliation(s)
- Francesco Oliva
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Eleonora Piccirilli
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Michela Bossa
- Department of Physical and Rehabilitation medicine, School of Medicine, University of Rome "Tor Vergata", Italy
| | - Alessio Giai Via
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | | | - Claudio Chillemi
- Department of Orthopaedic and Traumatology, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - Giuseppe Gasparre
- Department of Physical and Rehabilitation Medicine, University of Padua, Italy
| | - Leonardo Pellicciari
- Department of Physical and Rehabilitation medicine, School of Medicine, University of Rome "Tor Vergata", Italy
| | - Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Italy
| | - Clelia Rugiero
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Alessandro Scialdoni
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Filippo Vittadini
- Department of Physical and Rehabilitation Medicine, University of Padua, Italy
| | | | - Domenico Creta
- Physical Therapy and Rehabilitation Service, Private Hospital "Madre Fortunata Toniolo", Bologna, Italy
| | - Angelo Del Buono
- Orthopaedics and Traumatology, Ospedale Sant'Anna, Sanfermo della Battaglia, Como, Italy
| | - Raffaele Garofalo
- Shoulder Service, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Italy
| | - Antonio Frizziero
- Department of Physical and Rehabilitation Medicine, University of Padua, Italy
| | - Asmaa Mahmoud
- Department of Physical and Rehabilitation medicine, School of Medicine, University of Rome "Tor Vergata", Italy
| | - Giovanni Merolla
- Shoulder and Elbow Unit Biomechanics Laboratory "M. Simoncelli" D. Cervesi Hospital, Cattolica, Italy
| | - Simone Nicoletti
- Department of Orthopaedics and Traumatology, San Jacopo Hospital, Italy
| | - Marco Spoliti
- Department of Orthopaedics and Traumatology, San Camillo Hospital, Rome, Italy
| | - Leonardo Osti
- Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy
| | - Johnny Padulo
- Sport Science, University e-Campus, Novedrate, Italy; Tunisian Research Laboratory "Sports Performance Optimization", National Center of Medicine and Science in Sport, Tunis, Tunisia
| | - Nicola Portinaro
- UO Pediatric Orthopaedics, Humanitas Research Hospital, Milano, Italy
| | | | - Alex Castagna
- Shoulder and Elbow Unit, IRCCS Humanitas Institute, Rozzano, Milano, Italy
| | - Calogero Foti
- Department of Physical and Rehabilitation medicine, School of Medicine, University of Rome "Tor Vergata", Italy
| | - Stefano Masiero
- Department of Physical and Rehabilitation Medicine, University of Padua, Italy
| | - Giuseppe Porcellini
- Shoulder and Elbow Unit Biomechanics Laboratory "M. Simoncelli" D. Cervesi Hospital, Cattolica, Italy
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Nicola Maffulli
- Head of Department of Orthopaedics and Traumatology, Azienda Ospedaliera San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK
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28
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Radnovich R, Trudeau J, Gammaitoni AR. A randomized clinical study of the heated lidocaine/tetracaine patch versus subacromial corticosteroid injection for the treatment of pain associated with shoulder impingement syndrome. J Pain Res 2014; 7:727-35. [PMID: 25525385 PMCID: PMC4266383 DOI: 10.2147/jpr.s63118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Treatment for pain due to shoulder impingement syndrome (SIS) typically begins conservatively with nonsteroidal anti-inflammatory drugs and physical therapy and can include subacromial injection of corticosteroids, particularly in patients unresponsive to conservative measures. The heated lidocaine/tetracaine (HLT) patch has been reported to reduce SIS pain in a small case series. Methods This was a prospective, randomized, open-label clinical trial in which adult patients with SIS pain lasting at least 14 days, with an average intensity of ≥4 on a 0–10 scale (0= no pain, 10= worst pain) were randomized to treatment with the HLT patch or a single subacromial injection of triamcinolone acetonide (10 mg). Patients in the HLT patch group applied a single HLT patch to the shoulder for 4 hours twice daily, with a 12-hour interval between treatments during the first 14 days, and could continue to use the patch on an as-needed basis (up to twice daily) during the second 14-day period. No treatment was allowed in the final 14-day period. At baseline and at days 14, 28, and 42, patients rated their pain and pain interference with specific activities (0–10 scale). Results Sixty patients enrolled in the study (average age =51 years, range 18–75, n=21 female). Average pain scores declined from 6.0±1.6 at baseline to 3.5±2.4 at day 42 in the HLT patch group (n=29, P<0.001) and from 5.6±1.2 to 3.2±2.6 in the injection group (n=31, P<0.001). Similar improvements were seen in each group for worst pain; pain interference with general activity, work, or sleep; and range of motion. No significant between-group differences were seen for any pain or pain interference scores at any time point. Conclusion These results suggest that short-term, noninvasive treatment with the HLT patch has similar efficacy to subacromial corticosteroid injections for the treatment of pain associated with SIS.
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29
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Haslerud S, Magnussen LH, Joensen J, Lopes‐Martins RAB, Bjordal JM. The Efficacy of Low‐Level Laser Therapy for Shoulder Tendinopathy: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2014; 20:108-25. [DOI: 10.1002/pri.1606] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/03/2014] [Accepted: 08/21/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Sturla Haslerud
- Centre for Evidence Based Practice, Faculty of Health and Social SciencesNorPhyPain Research Group, Bergen University College Bergen Norway
- Department of Global Public Health and Primary Care, Physiotherapy Research GroupUniversity of Bergen Bergen Norway
| | - Liv Heide Magnussen
- Department of Global Public Health and Primary Care, Physiotherapy Research GroupUniversity of Bergen Bergen Norway
- Department of Occupational Therapy, Physiotherapy and RadiographyFaculty of Health and Social Sciences, Bergen University College Bergen Norway
| | - Jon Joensen
- Department of Global Public Health and Primary Care, Physiotherapy Research GroupUniversity of Bergen Bergen Norway
- Department of Occupational Therapy, Physiotherapy and RadiographyFaculty of Health and Social Sciences, Bergen University College Bergen Norway
| | | | - Jan Magnus Bjordal
- Centre for Evidence Based Practice, Faculty of Health and Social SciencesNorPhyPain Research Group, Bergen University College Bergen Norway
- Department of Global Public Health and Primary Care, Physiotherapy Research GroupUniversity of Bergen Bergen Norway
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30
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De Yang Tien J, Tan AHC. Shoulder Impingement Syndrome, a Common Affliction of the Shoulder: A Comprehensive Review. PROCEEDINGS OF SINGAPORE HEALTHCARE 2014. [DOI: 10.1177/201010581402300406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The shoulder joint is the most mobile joint in the human body. It comprises a ball and socket structure that enables a series of functional movements to be carried out. These range from simple movements such as reaching for the top shelf to highly explosive overhead activities which involve throwing a baseball or serving with a tennis racquet as seen in athletes. Shoulder impingement syndrome (SIS) is one of the most common shoulder disorders seen in general practice. It is caused by a multitude of factors. Pathology can arise either from the rotator cuff tendon itself, structures external to this tendon or both in combination. The resultant shoulder pain with SIS not only causes distress but also limits the quality of life of patients. This article aims to provide a comprehensive review of the pathogenesis, aetiologies, clinical tests, investigations and management options for SIS based on current literature and research.
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31
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Gebremariam L, Hay EM, van der Sande R, Rinkel WD, Koes BW, Huisstede BMA. Subacromial impingement syndrome--effectiveness of physiotherapy and manual therapy. Br J Sports Med 2013; 48:1202-8. [PMID: 24217037 DOI: 10.1136/bjsports-2012-091802] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The subacromial impingement syndrome (SIS) includes the rotator cuff syndrome, tendonitis and bursitis of the shoulder. Treatment includes surgical and non-surgical modalities. Non-surgical treatment is used to reduce pain, to decrease the subacromial inflammation, to heal the compromised rotator cuff and to restore satisfactory function of the shoulder. To select the most appropriate non-surgical intervention and to identify gaps in scientific knowledge, we explored the effectiveness of the interventions used, concentrating on the effectiveness of physiotherapy and manual therapy. METHODS The Cochrane Library, PubMed, EMBASE, PEDro and CINAHL were searched for relevant systematic reviews and randomised clinical trials (RCTs). Two reviewers independently extracted data and assessed the methodological quality. A best-evidence synthesis was used to summarise the results. RESULTS Two reviews and 10 RCTs were included. One RCT studied manual therapy as an add-on therapy to self-training. All other studies studied the effect of physiotherapy: effectiveness of exercise therapy, mobilisation as an add-on therapy to exercises, ultrasound, laser and pulsed electromagnetic field. Moderate evidence was found for the effectiveness of hyperthermia compared to exercise therapy or ultrasound in the short term. Hyperthermia and exercise therapy were more effective in comparison to controls or placebo in the short term (moderate evidence). For the effectiveness of hyperthermia, no midterm or long-term results were studied. In the midterm, exercise therapy gave the best results (moderate evidence) compared to placebo or controls. For other interventions, conflicting, limited or no evidence was found. CONCLUSIONS Some physiotherapeutic treatments seem to be promising (moderate evidence) to treat SIS, but more research is needed before firm conclusions can be drawn.
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Affiliation(s)
- Lukas Gebremariam
- Department of General Practice, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elaine M Hay
- Arthritis Research Campaign National Primary Care Centre, Keele University, Keele, UK
| | - Renske van der Sande
- Department of General Practice, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Willem D Rinkel
- Department of Rehabilitation Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bionka M A Huisstede
- Department of General Practice, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Rehabilitation Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
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