Background and Purpose: Subacromial impingement syndrome (SIS) is one of the most frequently reported causes of shoulder pain, and projects to become more prevalent as the population ages. Corticosteroid injections are a first-line treatment for SIS, however, the efficacy of corticosteroid use is controversial, and may not be superior to physical therapy treatment for long-term outcomes. This study compares the short-term and long-term outcomes of physical therapy and corticosteroid injections in the management of SIS, and aims to identify an optimal treatment strategy.
Case Description: A 55 year-old female presents to outpatient physical therapy for chronic right shoulder pain. The patient demonstrates positive results of the Neer impingement test, Hawkins impingement test, and the painful arc sign, as well as pain with shoulder elevation, weakness, difficulty sleeping on the right side, and tenderness to palpation. Following examination and conclusion of signs and symptoms, the patient was diagnosed with subacromial impingement syndrome. The patient was re-evaluated following 8 weeks of conservative treatment in physical therapy involving postural interventions, strengthening, stretching, and scapular and glenohumeral stabilization. The patient had clear preference for physical therapy over corticosteroid injections due to the invasiveness of the procedure. The patient did not report complete resolution of her symptoms, but improved significantly in her functional mobility and pain, and reported willingness to return to prior activities.
Outcomes: Nine articles were identified through literature searches and critically analyzed and evaluated. The literature supports a multitude of manual therapy and exercise-based treatments for the effective management of SIS in long-term outcomes, and also supports some short-term use of corticosteroid injections.
Discussion: High quality research involving the use of physical therapy and corticosteroid injections for the management of subacromial impingement syndrome is lacking. Examination of short-term and long-term outcomes of each treatment needs further critical analyses, especially in the development of specific protocols. The long-term use of corticosteroid injections may be harmful, and alternative treatments, such as physical therapy, should be considered first when providing holistic care for chronic conditions such as SIS. Based on the review of the research, it can be inferred that physical therapy is a more safe and effective treatment for long-term recovery and management of SIS, and rotator cuff eccentrics, scapular stabilization, and shoulder girdle stretching show to be the most effective physical therapy treatments overall.
Doctor of Physical Therapy (DPT)
Level of Degree
Ron Andrews, PT, PhD, OCS
physical, therapy, corticosteroid, injection, impingement, subacromial, shoulder
Jilek, Michelle A.. "The Efficacy of Physical Therapy Intervention versus Corticosteroid Injection for Management of Subacromial Impingement Syndrome." (2017). http://digitalrepository.unm.edu/dpt/125