Effectiveness of Passive Physical Modalities for Shoulder Pain: A Systematic Review by the Ontario Protocol for Traffic Injury Management Collaboration.

BACKGROUND:

Shoulder pain is a common musculoskeletal condition in the general population. Passive physical modalities are commonly used to treat shoulder pain. However, previous systematic reviews report conflicting results.

PURPOSE:

To evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the shoulder.

DATA SOURCES:

MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from January 1(st), 1990 to April 18(th), 2013.

STUDY SELECTION:

Randomized controlled trials (RCTs), cohort and case-control studies were eligible. Random pairs of independent reviewers screened 1470 of 1760 retrieved articles after removing 290 duplicates. Twenty-two articles were eligible for critical appraisal. We critically appraised the eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Of those, 11 studies had a low risk of bias.

DATA EXTRACTION:

The lead author extracted data from low risk of bias studies and built evidence tables. A second reviewer independently checked the extracted data.

DATA SYNTHESIS:

We synthesized the findings of low risk of bias studies according to principles of best evidence synthesis. We found that pre-tensioned tape, ultrasound and interferential current are not effective to manage shoulder pain. However, diathermy and corticosteroid injections lead to similar outcomes. Low-level laser therapy provides short-term pain reduction for subacromial impingement syndrome. Extracorporeal shock-wave therapy is not effective for subacromial impingement syndrome but it provides benefits for persistent shoulder calcific tendonitis.

LIMITATIONS:

Non-English studies excluded.

CONCLUSIONS:

Most passive physical modalities do not benefit patients with subacromial impingement syndrome. However, low-level laser therapy is more effective than placebo or ultrasound for subacromial impingement syndrome. Similarly, shock-wave therapy is more effective than sham for persistent shoulder calcific tendinitis.