Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomised, single blind study Jan C Winters, Jan S Sobel, Klaas H Groenier, Hans J Arendzen, Betty Meyboom-de Jong Abstract Objective: To compare the efficacy of physiotherapy, manipulation, and corticosteroid injection for treating patients with shoulder complaints in general practice. Design: Randomized, single blind study. Setting: Seven general practices in the Netherlands. Subjects: 198 patients with shoulder complaints, of whom 172 were divided, on the basis of physical examination, into two diagnostic groups: a shoulder girdle group (n=58) and a synovial group (n=114). Interventions: Patients in the shoulder girdle group were randomized to manipulation or physiotherapy, and patients in the synovial group were randomized to corticosteroid injection, manipulation, or physiotherapy. Main outcome measures: Duration of shoulder complaints analyzed by survival analysis. Results: In the shoulder girdle group duration of complaints was significantly shorter after manipulation compared with physiotherapy (P<0.001). 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 (P<0.001). 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. Department of General Practice, University of Groningen, Ant Deusinglaan 4, 9713 AW Groningen, Netherlands Jan C Winters, general practitioner Jan S Sobel, general practitioner Klaas H Groenier, statistician Betty Meyboom-de Jong, professor of general practice Department of Rehabilitation Medicine, University Hospital Groningen, 9700 RB, Groningen, Netherlands Hans J Arendzen, medical director of clinic for rehabilitation medicine, "Beatrixoord" Correspondence to: Dr J C Winters, Nieuwe Schoolweg 2A, 9756 BB Glimmen, Netherlands.
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