Subacromial corticosteroid injection or acupuncture with home exercises when treating patients with subacromial impingement in primary care--a randomized clinical trial.

BACKGROUND Patients with subacromial impingement syndrome (SIS) commonly seek primary care. Subacromial corticosteroid injection is the standard treatment given by GPs, which is supported by earlier studies reporting a positive effect but inconclusive evidence over the long- term. In Sweden, physiotherapists often choose acupuncture combined with exercises to treat SIS, which was reported as probably efficacious. OBJECTIVE To compare the efficacy of subacromial corticosteroids injected by a GP with physiotherapy combining acupuncture and home exercises as treatments for SIS. METHODS A randomized clinical trial was performed in primary health care. Patients diagnosed with SIS were randomized to either subacromial corticosteroid injection(s) or 10 acupuncture treatments combined with home- exercises. The main outcomes were pain and shoulder function (Adolfsson-Lysholm shoulder assessment score). Secondary outcomes were health-related quality of life (HRQL) (EuroQol-five dimension self-report questionnaire) and the patients' global assessment of change. All patients were assessed at baseline and after 6 weeks and 3, 6 and 12 months. RESULTS One hundred and seventeen patients with SIS were included, of which 91 complied with the study protocol. There were no significant differences between treatments with regard to pain, shoulder function and HRQL in change over time. However, both treatment groups improved significantly from baseline over time. CONCLUSIONS Both subacromial corticosteroid injection and a series of acupuncture treatments combined with home exercises significantly decreased pain and improved shoulder function in patients with SIS, but neither treatment was significantly superior to the other.