Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs

Ruedi Steuri; Martin Sattelmayer; Simone Elsig; Chloé Kolly; Amir Tal; Jan Taeymans; Roger Hilfiker

doi:10.1136/bjsports-2016-096515

Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs

Br J Sports Med. 2017 Sep;51(18):1340-1347. doi: 10.1136/bjsports-2016-096515. Epub 2017 Jun 19.

Authors

Ruedi Steuri^{1

2}, Martin Sattelmayer^{2

3}, Simone Elsig^{2

3}, Chloé Kolly^{2

3}, Amir Tal¹, Jan Taeymans^{1

4}, Roger Hilfiker^{2

3}

Affiliations

¹ Department of Health, Bern University of Applied Sciences, Berne, Switzerland.
² Department of Physiotherapy, University of Applied Sciences Western Switzerland, Leukerbad, Switzerland.
³ School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland Valais, Leukerbad, Switzerland.
⁴ Faculty of Sport and Rehabilitation Science, Vrije Universiteit Brussel, Brussels, Belgium.

Abstract

Objective: To investigate the effectiveness of conservative interventions for pain, function and range of motion in adults with shoulder impingement.

Design: Systematic review and meta-analysis of randomised trials.

Data sources: Medline, CENTRAL, CINAHL, Embase and PEDro were searched from inception to January 2017.

Study selection criteria: Randomised controlled trials including participants with shoulder impingement and evaluating at least one conservative intervention against sham or other treatments.

Results: For pain, exercise was superior to non-exercise control interventions (standardised mean difference (SMD) -0.94, 95% CI -1.69 to -0.19). Specific exercises were superior to generic exercises (SMD -0.65, 95% CI -0.99 to -0.32). Corticosteroid injections were superior to no treatment (SMD -0.65, 95% CI -1.04 to -0.26), and ultrasound guided injections were superior to non-guided injections (SMD -0.51, 95% CI -0.89 to -0.13). Nonsteroidal anti-inflammatory drugs (NSAIDS) had a small to moderate SMD of -0.29 (95% CI -0.53 to -0.05) compared with placebo. Manual therapy was superior to placebo (SMD -0.35, 95% CI -0.69 to -0.01). When combined with exercise, manual therapy was superior to exercise alone, but only at the shortest follow-up (SMD -0.32, 95% CI -0.62 to -0.01). Laser was superior to sham laser (SMD -0.88, 95% CI -1.48 to -0.27). Extracorporeal shockwave therapy (ECSWT) was superior to sham (-0.39, 95% CI -0.78 to -0.01) and tape was superior to sham (-0.64, 95% CI -1.16 to -0.12), with small to moderate SMDs.

Conclusion: Although there was only very low quality evidence, exercise should be considered for patients with shoulder impingement symptoms and tape, ECSWT, laser or manual therapy might be added. NSAIDS and corticosteroids are superior to placebo, but it is unclear how these treatments compare to exercise.

Keywords: Conservative; Meta-Analysis; Pain; Shoulder Impingement; Systematic Review.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Comparative Effectiveness Research
Exercise Therapy*
Humans
Laser Therapy
Musculoskeletal Manipulations*
Randomized Controlled Trials as Topic
Range of Motion, Articular
Shoulder Impingement Syndrome / therapy*
Shoulder Pain / therapy