Skip the steroids for shoulder pain?

August 5, 2014 by Steven Reinberg, Healthday Reporter
Skip the steroids for shoulder pain?
Physical therapy as effective as injections, researchers say.

(HealthDay)—For relief of shoulder pain, physical therapy and steroid shots provide similar results, a new study finds.

Researchers compared the two nonsurgical approaches in a group of 100-plus adults suffering from caused by rotator cuff problems, tendinitis or bursitis.

"Whether you had a steroid injection or , the improvement in each group was the same," said lead researcher Daniel Rhon, from the Center for the Intrepid at Brooke Army Medical Center at Fort Sam Houston, Texas.

"It was also a rather large improvement, about 50 percent, and this improvement was maintained for at least one year," he said.

But the group that received injections used more health care services and had significantly more shoulder-related doctor visits during the year of the study, Rhon said.

"Additional visits to your primary care provider may indicate that you had a persistent problem and were seeking further follow-up," he said.

In addition, 20 percent of those who got injections ended up going to physical therapy anyway, and about 40 percent who got shots needed more than one injection, Rhon said.

"While we don't know for sure, needing another injection would likely indicate that they still had persistent pain, especially because additional injections were optional," he said.

About one in five in the physical therapy group also got an during the year of follow-up, Rhon said.

The findings should reassure patients who prefer to avoid injections. "Some patients really do not like injections, so physical therapy may be a great and effective option," Rhon said.

The report was published Aug. 4 in the Annals of Internal Medicine.

Dr. Michael Hausman, a professor of orthopedic surgery at Mount Sinai Medical Center in New York City, said the findings "seem contradictory to my experience in practice."

Most of his patients who opt for physical therapy say their pain got worse with therapy, Hausman said.

"Probably the reason for that was that the therapy involves strengthening exercises, so patients are stressing the tendons that are damaged," he explained. "It's not surprising that the therapy would aggravate the symptoms."

Hausman thinks that steroid injections work and should be part of treatment if physical therapy isn't enough.

"If the joint is stiff, you should do stretching exercises to restore full motion. You should avoid exercises that put a strain on the tendon," he said. "If the symptoms persist and limit activity, then I would recommend a with a maximum of two injections."

Shoulder pain is a very common condition, and treatment decisions aren't uniform, said Dr. Michael Mizhiritsky, a physiatrist at Lenox Hill Hospital in New York City. "An accurate diagnosis needs to be established before initiating treatment. An experienced physician needs to evaluate a patient and consider diagnostic tests, such as X-ray and MRI," he said. "Only then should treatment begin."

Treatment should include physical therapy, Mizhiritsky said. "Steroid injections should be considered either before starting physical therapy or anytime there is no significant timely improvement, and a home exercise program needs to be followed," he added.

For the study, Rhon's team randomly assigned 104 patients with shoulder pain between the ages of 18 and 65 to receive steroid injections or six sessions of physical therapy over six weeks. Participants reported on their pain throughout the study.

During the year of the study, those receiving steroids could have as many as three injections.

Physical therapy included a combination of joint and soft-tissue manipulations, stretches, muscle contraction-relaxation techniques and exercises to promote movement in the shoulder, chest or neck. These patients also were given exercises they could do at home that reinforced the therapy.

Explore further: Shoulder replacement eases pain, improves motion in rheumatoid arthritis patients, study finds

More information: For more information on shoulder pain, visit the American Academy of Orthopedic Surgeons.

Related Stories

Shoulder replacement eases pain, improves motion in rheumatoid arthritis patients, study finds

January 13, 2014
Shoulder arthritis is a common problem for rheumatoid arthritis patients: pain and difficulty moving their arms can grow so severe that daily tasks and sleep become difficult. If medication and physical therapy aren't enough, ...

Steroid injection may lead to worse outcomes in patients with spinal stenosis

February 19, 2013
For patients with spinal stenosis, epidural steroid injections (ESI) may actually lead to worse outcomes—whether or not the patient later undergoes surgery, according to a study in the February 15 issue of Spine.

Physical therapy for hip osteoarthritis does not provide greater improvement for pain

May 20, 2014
Among adults with painful hip osteoarthritis, physical therapy did not result in greater improvement in pain or function compared with a placebo treatment, but was associated with relatively frequent but mild adverse effects, ...

Steroid injection linked with significant bone loss in postmenopausal women treated for back pain

December 1, 2012
Postmenopausal women suffered significant bone density loss in their hip after they were treated with an epidural steroid injection for back pain relief, according to a Henry Ford Hospital study

Steroid injection linked to increased risk of bone fractures

October 25, 2012
Patients treated with an epidural steroid injection for back pain relief are at increased risk of bone fractures in the spine, according to a Henry Ford Hospital study.

Studies of nonoperative tx for discogenic back pain lacking

July 24, 2014
(HealthDay)—High-quality studies evaluating nonoperative treatments for reducing discogenic low back pain are lacking, according to a review published in the July 15 issue of Spine.

Recommended for you

Study reveals how MRSA infection compromises lymphatic function

January 17, 2018
Infections of the skin or other soft tissues with the hard-to-treat MRSA (methicillin-resistant Staphylococcus aureus) bacteria appear to permanently compromise the lymphatic system, which is crucial to immune system function. ...

Fresh approach to tuberculosis vaccine offers better protection

January 17, 2018
A unique platform that resulted in a promising HIV vaccine has also led to a new, highly effective vaccine against tuberculosis that is moving toward testing in humans.

New study validates clotting risk factors in chronic kidney disease

January 17, 2018
In late 2017, researchers from Boston University School of Medicine (BUSM) discovered and published (Science Translational Medicine, (9) 417, Nov 2017) a potential treatment target to prevent chronic kidney disease (CKD) ...

Newly-discovered TB blood signal provides early warning for at-risk patients

January 17, 2018
Tuberculosis can be detected in people with HIV infection via a unique blood signal before symptoms appear, according to a new study by researchers from the Crick, Imperial College London and the University of Cape Town.

New study offers insights on genetic indicators of COPD risk

January 16, 2018
Researchers have discovered that genetic variations in the anatomy of the lungs could serve as indicators to help identify people who have low, but stable, lung function early in life, and those who are particularly at risk ...

Previous influenza virus exposures enhance susceptibility in another influenza pandemic

January 16, 2018
While past exposure to influenza A viruses often builds immunity to similar, and sometimes different, strains of the virus, Canadian researchers are calling for more attention to exceptions to that rule.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.