Background Subacromial impingement syndrome is the most common reason for shoulder pain which represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears. Management includes physical therapy, injections, and in some cases surgery.
Objectives To compare the efficacy of subacromial corticosteroid injection, physical therapy and exercise package treatment with the efficacy of physical therapy and exercise package treatment in patients with subacromial impingement syndrome.
Methods Sixty patients with diagnosis of subacromial impingement syndrome were recruited consecutively into the study. Patients were divided into two groups. Thirty subjects recruited in Group1 where subacromial corticosteroid injection (Triamcinolone Acetonide 40mg/1ml, once at onset), physical therapy (hot pack, TENS and ultrasound-1.5Watt/cm2) and 3 phases shoulder home exercise programme (twice a day during 3 months) were applied. Another 30 subjetcs recruited in Group2 where physical therapy and 3 phases shoulder home exercises were applied with same protocol. Patients in both groups were assessed before treatment and at 15th day, 1st and 3rd months after treatment. The shoulder specific examination tests (Neer, Hawkins, Jobe, painful arc) were assessed. The shoulder pain at rest, during movement, and at night were assessed using visual analog scales (VAS). All subgroups (range of motion, daily activities etc) of Constant Murley Score (CMS) and Disability of Arm, Shoulder and Hand Questionnaire (DASH) were managed to all subjects. Wilcoxon, McNemar, Mann Whitney U methods were used for statistical analysis. p<0.05 accepted as significant.
Results Sixty patients (50 female) with 55.6 (SD: 8.1) years of mean aged and 6.4 (SD:5.5) months of disease duration were recruited into the study. There were not statistically significant difference between Group1 and Group2 regarding age, gender, disease duration and affected side (p>0.05). The statistically significant improvement was obtained in pain at rest, during movement and at night in both groups, at all evaluations after treatment when compared to baseline values (p<0.05). In both groups, statistically significant improvements were determined in daily activities, shoulder specific examination tests, and range of motion subscales of CMSs and DASH scores in all evaluations after treatment when compared to baseline values (p<0.05).
The daily activities subgroup of CMS was significantly improved in group 1 at 1st month compared to group 2 (p<0.05). There were not statistically significant difference exist of other CMS subgroups between group 1 and group 2 patients. The improvement observed in Group 1 at 1st month and 3rd month was significantly greater than that in Group 2 (p<0.05).
Conclusions In subacromial impingement syndrome physical therapy with exercises is effective treatment whose effect is maintained minimum 3 months. Addition of subacromial corticosteroid injection to this treatment promotes the improvement of functional status of the patients. Furthermore, they perform exercises less painfull and comfortably during the early period after injection.
Disclosure of Interest None Declared