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General Practice

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

BMJ 1997; 314 doi: (Published 03 May 1997) Cite this as: BMJ 1997;314:1320
  1. Jan C Winters, general practitionera,
  2. Jan S Sobel, general practitionera,
  3. Klaas H Groenier, statisticiana,
  4. Hans J Arendzen, medical director of clinic for rehabilitation medicine “Beatrixoord”b,
  5. Betty Meyboom-de Jong, professor of general practicea
  1. a Department of General Practice, University of Groningen, Ant Deusinglaan 4, 9713 AW Groningen, Netherlands
  2. b Department of Rehabilitation Medicine, University Hospital Groningen, 9700 RB, Groningen, Netherlands
  1. Correspondence to: Dr J C Winters Nieuwe Schoolweg 2A, 9756 BB Glimmen, Netherlands.
  • Accepted 24 January 1997


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 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 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 analysed 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.

Key messages

  • Many patients with shoulder complaints are treated in general practice, but there has been little evaluation of different treatments

  • In this single blind randomised trial we investigated the effect of corticosteroid injection, manipulation, and physiotherapy on the duration of shoulder complaints among patients treated in general practice

  • Patients were divided into two diagnostic groups: those with complaints originating from the synovial structures and those whose complaints originated from the shoulder girdle

  • The first group was treated by injection, manipulation, or physiotherapy: those receiving injection showed quickest recovery and only 17% of patients dropped out because of treatment failure, compared with 51% in physiotherapy group and 59% in manipulation group

  • Patients with a shoulder girdle disorder were treated by manipulation or physiotherapy: duration of complaints was significantly shorter after manipulation, and there was only 20% drop out in this group compared with 45% in physiotherapy group


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