Comparison of the efficacy of physiotherapy, subacromial corticosteroid, and subacromial hyaluronic acid injection in the treatment of subacromial impingement syndrome: a retrospective study

Abstract

Background: The optimal nonoperative management for subacromial impingement syndrome (SIS) is unclear. This study evaluated the efficacy of subacromial corticosteroid, hyaluronic acid injection and physiotherapy in patients with SIS to determine which treatment is most effective. Methods: SIS patients treated with either physiotherapy or subacromial injection of triamcinolone (40 mg), or subacromial hyaluronic acid injection were included in this retrospective study. The outcome measures were evaluated 3 and 6 mo after the intervention and included pain evaluated by a visual analog scale (VAS) and limb function assessed by the Disabilities of the Arm, Shoulder, and Hand (DASH) and American Shoulder and Elbow Surgeons (ASES) questionnaires. Results: Eighty-eight patients with SIS were included. Treatment was done with corticosteroid injection in 31 patients, hyaluronic acid injection in 30 patients, and physiotherapy in 27 patients. The mean improvement of VAS, DASH, and ASES scores of the corticosteroid group was significantly higher when compared with the physiotherapy group at 3 mo (P=0.035, P<0.001, and P<0.001, respectively) and 6 mo (P=0.036, P<0.001, and P<0.001, respectively), also in comparison with the hyaluronic acid group at 3 mo (P=0.038, P<0.001, and P=0.002, respectively) and 6 mo (P=0.044, P<0.001, P<0.001, respectively). The mean improvement of DASH and ASES scores, but not VAS, was significantly higher in the hyaluronic acid group compared to the physiotherapy group at 3 mo (P=0.022, P=0.034, and P=0.55, respectively) and 6 mo (P=0.46, P=0.039, and P=0.51, respectively). Conclusions: Subacromial corticosteroid injection is more effective than physiotherapy and hyaluronic acid injection in treating SIS symptoms. Level of Evidence: Level III.