Effectiveness of passive physical modalities for shoulder pain: systematic review by the Ontario protocol for traffic injury management collaboration

Phys Ther. 2015 Mar;95(3):306-18. doi: 10.2522/ptj.20140361. Epub 2014 Nov 13.

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Yu H1, Côté P2, Shearer HM3, Wong JJ4, Sutton DA5, Randhawa KA6, Varatharajan S7, Southerst D8, Mior SA9, Ameis A10, Stupar M11, Nordin M12, van der Velde GM13, Carroll L14, Jacobs CL15, Taylor-Vaisey AL16, Abdulla S17, Shergill Y18.


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 reported conflicting results.


The aim of this study was to evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the shoulder.


MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials were searched from January 1, 1990, to April 18, 2013.


Randomized controlled trials (RCTs) and cohort and case-control studies were eligible. Random pairs of independent reviewers screened 1,470 of 1,760 retrieved articles after removing 290 duplicates. Twenty-two articles were eligible for critical appraisal. Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. Of those, 11 studies had a low risk of bias.


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


The findings of studies with a low risk of bias were synthesized according to principles of best evidence synthesis. Pretensioned tape, ultrasound, and interferential current were found to be noneffective for managing shoulder pain. However, diathermy and corticosteroid injections led to similar outcomes. Low-level laser therapy provided short-term pain reduction for subacromial impingement syndrome. Extracorporeal shock-wave therapy was not effective for subacromial impingement syndrome but provided benefits for persistent shoulder calcific tendinitis.


Non-English studies were excluded.


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

© 2015 American Physical Therapy Association.

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