Shoulder Pain and Immobility: Often, Less Is More

Subacute and chronic shoulder pain and immobility are common complaints in primary care practice. Clinicians might recommend physical therapy (PT) or joint injection and, in more complex cases, can refer patients for orthopedic consultation; however, limited evidence guides these decisions. In several randomized trials, investigators compared various approaches.

U.K. researchers randomized 500 adults with unilateral adhesive capsulitis (i.e., “frozen shoulder”) to manipulation under anesthesia or capsular release (each followed by as many as 12 sessions of PT), or to a single intra-articular steroid injection plus PT. One year later, manipulation and PT yielded similar outcomes for shoulder pain and function. Capsular release was statistical…