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General Practice

Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care: randomised trial

BMJ 1998; 317 doi: (Published 07 November 1998) Cite this as: BMJ 1998;317:1292
  1. D A W M der van Windta (dawm.van_der_windt.emgo{at}, senior investigator,
  2. B W Koesa, associate professor,
  3. W Devilléb, assistant professor,
  4. A J P Boekec, senior investigator,
  5. B A de Jongd, associate professor,
  6. L M Boutera, professor in epidemiology
  1. a Institute for Research in Extramural Medicine, Faculty of Medicine, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands
  2. b Department of Epidemiology and Biostatistics, Faculty of Medicine, Vrije Universiteit
  3. c Department of General Practice, Nursing Home Medicine and Social Medicine, Faculty of Medicine, Vrije Universiteit
  4. d Department of Rehabilitation Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam
  1. Correspondence to: Dr van der Windt
  • Accepted 14 August 1998


Objective : To compare the effectiveness of corticosteroid injections with physiotherapy for the treatment of painful stiff shoulder.

Design : Randomised trial.

Setting : 40 general practices.

Subjects : 109 patients consulting general practitioners for shoulder pain were enrolled in the trial.

Interventions : Patients were randomly allocated to 6 weeks of treatment either with corticosteroid injections (53) or physiotherapy (56).

Main outcome measures : Outcome assessments were carried out 3, 7, 13, 26, and 52 weeks after randomisation; some of the assessments were done by an observer blind to treatment allocation. Primary outcome measures were the success of treatment as measured by scores on scales measuring improvement in the main complaint and pain, and improvement in scores on a scale measuring shoulder disability.

Results : At 7 weeks 40 (77%) out of 52 patients treated with injections were considered to be treatment successes compared with 26 (46%) out of 56 treated with physiotherapy (difference between groups 31%, 95% confidence interval 14% to 48%). The difference in improvement favoured those treated with corticosteroids in nearly all outcome measures; these differences were statistically significant. At 26 and 52 weeks differences between the groups were comparatively small. Adverse reactions were generally mild. However, among women receiving treatment with corticosteroids adverse reactions were more troublesome: facial flushing was reported by 9 women and irregular menstrual bleeding by 6, 2 of whom were postmenopausal.

Conclusions : The beneficial effects of corticosteroid injections administered by general practitioners for treatment of painful stiff shoulder are superior to those of physiotherapy. The differences between the intervention groups were mainly the result of the comparatively faster relief of symptoms that occurred in patients treated with injections. Adverse reactions were generally mild but doctors should be aware of the potential side effects of injections of triamcinolone, particularly in women.


  • Funding Netherlands Organisation for Scientific Research and the Fund for Investigative Medicine of the Health Insurance Council.

  • Conflict of interest None.

  • Accepted 14 August 1998
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