Suppliers
- a
G*Power3; Heinrich-Heine-University, 40225 Düsseldorf, Germany. Available at: //www.psycho.uni-duesseldorf.de/abteilungen/aap/gpower3
Shoulder pain accounts for 33.2% of physician office visits for musculoskeletal pain in the United States. The prevalence of shoulder pain is 7% to 27% for adults and is increasing for women and older individuals. The most frequent cause of shoulder pain is subacromial impingement syndrome (SIS), which includes a number of pathological entities: rotator cuff syndrome, tendonitis and bursitis in the shoulder. SIS occurs when the soft tissues of the glenohumeral joint between the coracoacromial
This journal-based activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the sponsorship of the Elsevier Office of Continuing Medical Education (EOCME). The EOCME is accredited by the ACCME to provide continuing medical education (CME) for physicians.
The EOCME designates this journal-based activity for a maximum of 3.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity. All other health care professionals completing continuing education credit for this activity will be issued a certificate of participation.
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objective:
Describe the evidence-base supporting the effectiveness of corticosteroid injections for subacromial impingement syndrome
Demonstrate their ability to develop a treatment plan based on current evidence
Ji Yeon Hong, MD, Seung-Hyun Yoon, MD, PhD, Do Jun Moon, MD, Kyu-Sung Kwack, MD, PhD, Bohyun Joen, MD, Hyun Young Lee, MS, Tania Dickson, PhD.
As a sponsor accredited by the ACCME, it is the policy of the EOCME to require the disclosure of anyone who is in a position to control the content of an educational activity. All relevant financial relationships with any commercial interests and/or manufacturers must be disclosed to participants at the beginning of each activity. The faculty of this educational activity discloses the following:
Department of Physical Medicine and Rehabilitation
Ajou University School of Medicine and Ajou University Hospital, Suwon
Republic of Korea
Disclosures: Has nothing to disclose.
Department of Physical Medicine and Rehabilitation
Ajou University School of Medicine and Ajou University Hospital, Suwon
Republic of Korea
Disclosures: Has nothing to disclose.
Department of Physical Medicine and Rehabilitation
Goyang Healings Hospital, Goyang
Republic of Korea
Disclosures: Has nothing to disclose.
Department of Radiology
Ajou University School of Medicine and Ajou University Hospital, Suwon
Republic of Korea
Disclosures: Has nothing to disclose.
Department of Physical Medicine and Rehabilitation
Ajou Good Hospital, Suwon
Republic of Korea
Disclosures: Has nothing to disclose.
Regional Clinical Trial Center
Ajou University School of Medicine and Ajou University Hospital, Suwon
Republic of Korea
Disclosures: Has nothing to disclose.
Tania Dickson, PhD
Disclosures: Has nothing to disclose
The EOCME has implemented a process to resolve conflict of interest for each CME activity. In order to help ensure content objectivity, independence, and fair balance, and to ensure that the content is aligned with the interest of the public, the EOCME has resolved the conflict by external content review.
The EOCME requires CME faculty to disclose to the participants:
When products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not US Food and Drug Administration [FDA] approved); and
Any limitations on the information presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion. Faculty may discuss information about pharmaceutical agents that is outside of FDA-approved labeling. This
This program is intended for physicians and healthcare professionals responsible for the comprehensive care for individuals with chronic illness and disabilities.
In order to claim credit, participants must complete the following:
Pre-activity self-assessment questions
Read the activity
Complete the CME Test and Evaluation. Participants must achieve a score of 70% on the CME Test.
Participants can complete the pre-activity self-assessment and CME Test and Evaluation online by logging-on to http://www.elsevierOCME.com/910472-5. Upon successful completion of the online tests and evaluation form, you can instantly download and print your certificate of credit.
For all CME certificate inquiries, please contact Sandy Breslow at [email protected].
Release Date of Activity: December 2011
Expiration Date of Activity for
AMA PRA Credit: November 30, 2012
Estimated Time to Complete This Activity: 3.0 hours
Between October 2009 and September 2010, eligible participants with shoulder pain were recruited by displaying posters in the rehabilitation clinic of a university hospital in Suwon, Korea, and 2 other local outpatient clinics in Suwon and Goyang. All participants underwent a standardized history and physical examination. We also carried out active and passive range of movement and the painful arc test and checked for tenderness and/or swelling of the lesion in the affected shoulder.
The Neer17
Table 1 lists baseline characteristics of study participants, which were similar for all 3 randomization groups, whereas table 2 lists ultrasound findings of the affected shoulder.
To our knowledge, this is the first study to assess the efficacy of corticosteroid (triamcinolone acetonide) according to 2 different doses, which are the most widely used in subacromial injection for participants with periarticular shoulder disorders diagnosed clinically and ultrasonographically. Compared with pretreatment (within-group comparisons), the high- (triamcinolone, 40mg) and low-dose corticosteroid (triamcinolone, 20mg) groups showed improvement in pain, disability, and AROM,
This is the first study to assess the efficacy of corticosteroid according to 2 different doses (triamcinolone acetonide, 20mg, 40mg), which are the most widely used in subacromial injection for participants with periarticular shoulder disorders. Initial use of a low dose is encouraged because there was no difference in efficacy according to dose, and the effect of corticosteroid lasted up to 8 weeks.
G*Power3; Heinrich-Heine-University, 40225 Düsseldorf, Germany. Available at: //www.psycho.uni-duesseldorf.de/abteilungen/aap/gpower3Suppliers
We thank Aeree Park, MA, for translation of the manuscript.
However, the dosage of corticosteroid seems not to be a variable in the application of a local injection to treat CTS in the midterm. A lack of a dose-response relationship between corticosteroid injection and musculoskeletal diseases is quite common.35,36 The ceiling effect of corticosteroids in their anti-inflammatory and analgesic effects potentially illustrates the limited efficacy of corticosteroids at higher doses.
In addition, the maximum follow-up time in all the studies enrolled in the meta-analysis was 24 weeks, which is approximately half of our follow-up time. The need for such a long follow-up is justified by the fact that, in most of the studies, at the end of the follow-up period residual pain was reported as indicated by VAS scores higher than 2 [8,12,13]. The high-volume injection mixture in our study, apart from steroid agent, contained 2 mL lidocaine 1% plus 7 mL of bupivacaine.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.