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Skip the Steroids for Shoulder Pain?
Date:8/5/2014

el Hausman, a professor of orthopedic surgery at Mount Sinai Medical Center in New York City, said the findings "seem contradictory to my experience in practice."

Most of his patients who opt for physical therapy say their pain got worse with therapy, Hausman said.

"Probably the reason for that was that the therapy involves strengthening exercises, so patients are stressing the tendons that are damaged," he explained. "It's not surprising that the therapy would aggravate the symptoms."

Hausman thinks that steroid injections work and should be part of treatment if physical therapy isn't enough.

"If the joint is stiff, you should do stretching exercises to restore full motion. You should avoid exercises that put a strain on the rotator cuff tendon," he said. "If the symptoms persist and limit activity, then I would recommend a steroid injection with a maximum of two injections."

Shoulder pain is a very common condition, and treatment decisions aren't uniform, said Dr. Michael Mizhiritsky, a physiatrist at Lenox Hill Hospital in New York City. "An accurate diagnosis needs to be established before initiating treatment. An experienced physician needs to evaluate a patient and consider diagnostic tests, such as X-ray and MRI," he said. "Only then should treatment begin."

Treatment should include physical therapy, Mizhiritsky said. "Steroid injections should be considered either before starting physical therapy or anytime there is no significant timely improvement, and a home exercise program needs to be followed," he added.

For the study, Rhon's team randomly assigned 104 patients with shoulder pain between the ages of 18 and 65 to receive steroid injections or six sessions of physical therapy over six weeks. Participants reported on their pain throughout the study.

During the year of the study, those receiving steroids could have as many as three injections.

Physical therapy included a combination of joint and
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