Optimising treatment for patients with rotator cuff disorders

Physiotherapist-prescribed exercise programmes and subacromial corticosteroid injections are mainstays of management of rotator cuff disorders. Systematic reviews have consistently found short-term benefits of corticosteroid injection in relieving pain. 1 Buchbinder R Green S Youd JM Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. 2003; 1CD004016 PubMed Google Scholar , 2 Coombes BK Bisset L Vicenzino B Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010; 376: 1751-1767 Summary Full Text Full Text PDF PubMed Scopus (519) Google Scholar But there has been much less clarity around the value of exercise therapy, including its optimum type, intensity, and duration, despite a plethora of randomised controlled trials that have examined this question. 3 Page MJ Green S McBain B et al. Manual therapy and exercise for rotator cuff disease. Cochrane Database Syst Rev. 2016; 6CD012224 Google Scholar , 4 Granviken F Vasseljen O Home exercises and supervised exercises are similarly effective for people with subacromial impingement: a randomised trial. J Physiother. 2015; 61: 135-141 Crossref PubMed Scopus (26) Google Scholar , 5 Littlewood C Bateman M Brown K et al. A self-managed single exercise programme versus usual physiotherapy treatment for rotator cuff tendinopathy: a randomised controlled trial (the SELF study). Clin Rehabil. 2016; 30: 686-696 Crossref PubMed Scopus (48) Google Scholar , 6 Roddy E Ogollah RO Oppong R et al. Optimising outcomes of exercise and corticosteroid injection in patients with subacromial pain (impingement) syndrome: a factorial randomised trial. Br J Sports Med. 2021; 55: 262-271 Crossref PubMed Scopus (7) Google Scholar Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 × 2 factorial, randomised controlled trialProgressive exercise was not superior to a best practice advice session with a physiotherapist in improving shoulder pain and function. Subacromial corticosteroid injection provided no long-term benefit in patients with rotator cuff disorders. Full-Text PDF Open Access