A Manual Physical Therapy Approach Versus Subacromial Corticosteroid Injection for Treatment of Shoulder Impingement Syndrome

Dysfunction in the shoulder has been reported to affect up to 33% of the general population
and generate up to 5% of all consultations from general practitioners. Shoulder problems
have been reported as the second highest musculoskeletal complaint for those seeking care
from a physical therapist in a deployed environment. Impingement syndromes occur in nearly
anyone who repeatedly or forcefully uses their upper extremity in an elevated position,
which is very common in the active duty population, and is often characterized by pain
during this motion. Managed improperly, this can lead to disruption in work performance and
prolonged disability.

Corticosteroid and analgesic injections are some of the most common procedures for
orthopedists, rheumatologists, and general practitioners to use in the management of
shoulder pain. Conflicting reports from systematic reviews questions the efficacy of
corticosteroid injections over other interventions, including oral non-steroidal
anti-inflammatory drugs (NSAIDs). Additionally they are not without potential risk such as
infection or deleterious effects of prolonged corticosteroid use to include tissue
degeneration reported in animal studies as well as other regions of the human body. Manual
physical therapy offers a non-invasive approach with negligible risk in as few as three to
six sessions and has been shown to improve strength and function in this patient population.

The purpose of this study is to evaluate and compare the effectiveness of two interventions
that are commonly used in the management of shoulder impingement syndrome.

1. Evaluate the effect that a subacromial corticosteroid injection has on a subject's
function and pain as measured by the Shoulder Pain and Disability Index (SPADI).

2. Evaluate the effect that manual physical therapy has on a subject's function and pain
as measured by the Shoulder Pain and Disability Index (SPADI).

3. Compare the effect sizes of the two different interventions in a patient population
with shoulder impingement syndrome.