WINNER PHILIP FULFORD PRIZE: A RANDOMISED CONTROLLED TRIAL OF TREATMENT OF THE PAINFUL ARC OF THE SHOULDER – TPARC

Abstract

Introduction: Shoulder pain represents a significant burden of disease in the general population, yet there is a lack of evidence about the effectiveness of routinely used interventions such as corticosteroid injection and physiotherapy.

Methods: Over a six-month period patients with “painful arc” of less than six months duration were recruited via their GPs.

Eligible patients randomised to one of four arms of the study: control (normal analgesia and/or non-steroidal anti-inflammatory medication), a specified and repeatable Exercise and Manual Therapy Package (EMTP), a course of up to three subacromial steroid injections or both the EMTP and the steroid injections. Follow-up was for 18 weeks, with postal questionnaire at one year.

The primary outcome measure was the Oxford Shoulder Score (OSS).

Results: 186 patients were referred, 112 were randomised. Mean age was 54.5 years. Ninety patients completed the trial. Sixty-two returned the follow-up questionnaire.

By analysis of covariance, no significant differences were found between the OSS scores or SF-36 (physical health total) at the beginning and end of the trial, or at one year. Two patients in the injection group went on to surgery, along with one each in the control and EMTP groups. No significant differences were found between treatment groups.

Conclusion: We have found no significant differences in outcome between steroid injections, physiotherapy, both treatments, and symptomatic treatment in a group of patients with early painful arc of the shoulder. Further, larger studies may be needed to find small differences in outcome between these treatments.