Cost-effectiveness of local steroid combined with therapeutic exercise in subacromial impingement syndrome
Main Article Content
Keywords
Shoulder injuries, Shoulder, Shoulder impingement syndrome
Abstract
Background: The most common cause of injury is shoulder impingement syndrome. Management includes physical therapy, analgesics, steroids and surgery. The aim of the study was to determine the cost-effectiveness of using steroids combined with therapeutic exercise at home in the chronic impingement syndrome.
Methods: Clinical trial randomized in 30 people with subacromial impingement syndrome underwent two treatments: steroid and at home rehabilitation booklet evaluated at the first and fourth week through UCLA Shoulder rating scale.
Results: We studied 17 men (56.7%) and 13 women (43.3%), mean age was 42.87 years. Group 2 earned greater improvement in UCLA Shoulder rating scale 18.87 at baseline and 27.60 at the end. With 30.27 accumulated disability days for group 1, and 14.80 for group 2.
Conclusions: The combination of local steroids with therapeutic exercise is more effective clinically and declining disability compared to conventional physical therapy.
References
Dorrestijn O, Greving K, Van Der Veen WJ, Van Der MK, Diercks RL, Winters JC, Stevens M. Patients with shoulder complaints in general practice: consumption of medical care. Rheumatology. 2011;50(2):389-395.
Urwin M, Symmons D, Allison T, Brammah T, Busby H, Rox BY et al. Estimating the burden of musculoskeletal disorders in the community: The comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Annals of the Rheumatic Diseases. 1998;57(11):649-655.
Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. British Medical Journal. 2005;331(7525):1124-1128.
Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33:73-81.
Mohtadi NG, Vellet AD, Clark ML, Hollinshead RM, Sasyniuk TM, Fick GH et al. A prospective, double-blind comparison of magnetic resonance imaging and arthroscopy in the evaluation of patients presenting with shoulder pain. J Shoulder Elbow Surg. 2004;13(3):258-65.
MacDermid JC, Ramos J, Drosdowech D, Faber K, Patterson S. The impact of rotator cuff pathology on isometric and isokinetic strength, function, and quality of life. J Shoulder Elbow Surg. 2004;13:593-8.
Jones JR, Hodgson JT, Clegg TA, Elliott RC. Self-reported work-related illness in 1995; Norwich: HMSO; 1998.
Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain. 2000; 84:95-103.
Chartered Institute for of Personnel and Development: Absence management: annual survey 2009. London; CIPD; 2009.
In EQ-5D Value Sets: Inventory, Comparative Review and User Guide. Editado por: Szende A, Oppe M, Devlin N. London; 2007. Springer; Netherherlands
Nygren A, Berglund A, Von Koch M. Neck and shoulder pain: an increasing problem. Strategies for using insurance material to follow trends. Scand J Rehabil Med Suppl. 1995;32:107-12.
Kromer TO, Tautenhahn UG, de Bie RA, Staal JB, Bastiaenen CH. Effects of physiotherapy in patients with shoulder impingement syndrome: a systematic review of the literature. J Rehabil Med. 2009;41(11):870-80.
Smith M, Sparkes V, Busse M, Enright S. Upper and lower trapezius muscle activity in subjects with subacromial impingement symptoms: is there imbalance and can taping change it? Phys Ther Sport. 2009;10(2):45-50.
Linsell L, Dawson J, Zondervan K, Rose P, Randall T, Fitzpatrick R, Carr A. Prevalence and incidence of adults consulting for shoulder conditions in UK primary care; patterns of diagnosis and referral. Rheumatology. 2006;45(2):215-221.
Van den Dolder PA, Roberts DL. A trial into the effectiveness of soft tissue massage in the treatment of shoulder pain. Aust J Physiother. 2003;49(3):183-188.
Andrews JR. Diagnosis and treatment of chronic painful shoulder: review of nonsurgical interventions. Arthroscopy. 2005;21(3):333-347.
Arroll B, Goodyear-Smith F. Corticosteroid injections for painful shoulder: A meta-analysis. British Journal of General Practice. 2005;55(512):224-228.
James M, Stokes EA, Thomas E, Dziedzic K, Hay EM. A cost consequences analysis of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care. Rheumatology. 2005;44(11): 1447-1451.
Green S, Buchbinder R, Hetrick S. Intervenciones fisioterapéuticas para el dolor del hombro. The Cochrane Library. 2008, Tomo 1, No. 2, p. 65-75.
Ginn KA, Cohen ML. Exercise therapy for shoulder pain aimed at restoring neuromuscular control: a randomized comparative clinical trial. J Rehabil Med. 2005;37(2):115–122.
Crawshaw DP, Helliwell PS, Hensor EMA, Hay EM, Aldous SJ, Conaghan PG. Exercise therapy after corticosteroid injection for moderate to severe shoulder pain: Large pragmatic randomized trial. BMJ. 2010;340:c3037.
Ludewig P, Borstad J. Effects of a home exercise programme on shoulder pain and functional status in construction workers. Occup Environ Med. 2003; 60(11): 841-849.
Guías de Práctica Clínica. Diagnóstico y tratamiento del síndrome de hombro doloroso en primer nivel de atención. Gobierno federal. Consejo de salubridad general IMSS-085-08. Ciudad de México: Instituto Mexicano del Seguro Social; 2016.
Ellman H, Kay SP, Wirth M: Arthroscopic treatment of fullthickness rotator cuff tears: 2 to 7 year follow-up study. Arthroscopy. 1993;9:195-200.