Several treatment strategies are available for shoulder complaints in a primary care practice. A large study in the mid-1990s showed that corticosteroid injection was generally superior to physical therapy and manipulation when symptoms originated in the glenohumeral joint, subacromial space or acromioclavicular joint (the synovial group of complaints). When symptoms originated in the shoulder girdle, manipulation gave better results than physical therapy. This study was limited by its short duration; follow-up was limited to 11 weeks. In 1997, Winters and colleagues attempted to contact the patients from the original study to assess the long-term effects of treatment.
Questionnaires were sent to the original 172 patients, of whom 130 (76 percent) replied. The responders did not differ from nonresponders in any important variable. The proportion of patients reporting shoulder problems at least once since the earlier study was 52 percent of the synovial group and 73 percent of those with symptoms originating in the shoulder girdle. Irrespective of treatment, approximately one half of patients in each group reported limitations in daily activities because of shoulder symptoms. Regardless of treatment or diagnostic group, significant numbers of patients reported current symptoms, self-treatment and further consultation with general practitioners because of shoulder symptoms. No significant differences were found between the patient groups in any of the variables assessed.
The authors conclude that no significant differences in long-term outcomes could be found between patients treated by different modalities for painful shoulder symptoms. Overall, all treatments were unsatisfactory; approximately one half of the patients experienced recurrent complaints. The authors call for new studies to elucidate a better understanding of the etiology and optimal management of these common conditions.