I love this stuff

I’ve been injecting patients for 20 years. Recently a slightly nervous patient asked me how many I’ve done. Luckily I’d just been doing some stats so when I replied “I stopped counting at 1000” they seemed somewhat assured. The conversation usually progresses with these patients to “what is best, rest, physio, exercises or the injection.” So I use the article below to talk it through.

Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomised, single blind study

Jan C Winters, general practitioner, et al


Objective: To compare the efficacy of physiotherapy, manipulation, and corticosteroid injection for treating patients with shoulder complaints in general practice.

Design: Randomised, single blind study.

Setting: Seven general practices in the Netherlands.

Subjects: 198 patients into two diagnostic groups

Interventions: Patients in the shoulder girdle group were randomised to manipulation or physiotherapy, and patients in the synovial group were randomised to corticosteroid injection, manipulation, or physiotherapy.

Main outcome measures: Duration of shoulder complaints.

Results: In the shoulder girdle group duration of complaints was significantly shorter after manipulation compared with physiotherapy. Also the number of patients reporting treatment failure was less with manipulation. In the synovial group duration of complaints was shortest after corticosteroid injection compared with manipulation and physiotherapy. Drop out due to treatment failure was low in the injection group (17%) and high in the manipulation group (59%) and physiotherapy group (51%).

Conclusions: For treating shoulder girdle disorders, manipulation seems to be the preferred treatment. For the synovial disorders, corticosteroid injection seems the best treatment.

This seems to reinforce the message all lead clinicians are saying. Examine your patient, diagnose the condition and its subgroup, treat it with an appropriate treatment for that individual condition. Just as importantly understand your research – since when was manipulation not a part of physiotherapy!

BMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7090.1320 (Published 03 May 1997) Cite this as: BMJ 1997;314:1320