ShoulderA double-blind randomized controlled trial comparing the effects of subacromial injection with corticosteroid versus NSAID in patients with shoulder impingement syndrome
Section snippets
Materials and methods
Patients were recruited from a sports medicine orthopaedic surgery clinic in a tertiary care medical center. Briefly, the inclusion criteria were shoulder pain with passive and/or active abduction, diagnosis of subacromial bursitis based on tenderness to palpation about the acromion, positive Neer’s sign, positive Hawkin’s sign, and pain exacerbated with the shoulder held in internal rotation (Table I). In addition, all patients had standard radiographs of their affected shoulder to rule out
Results
Forty-eight patients met the inclusion and exclusion criteria (Table I) and were enrolled in the study. Of the 48 patients, 24 patients were randomized to the steroid group and 24 patients to the NSAID group. Ten patients were lost to follow-up (7 steroid, 3 NSAID), 1 patient’s consent expired (steroid), and 5 patients were later determined by magnetic resonance imaging (MRI) to have a rotator cuff tear (1 steroid, 4 NSAID). This left 15 patients in the steroid group (average age 40 years;
Discussion
In this study, we used an injectable NSAID to provide a localized area of anti-inflammatory action. Our study suggests that at 4 weeks, NSAID injection has superior efficacy compared to corticosteroid injections, as measured by improvement in the UCLA shoulder rating scale and forward flexion strength. One possible explanation could be that ketorolac has a longer half-life than triamcinolone (ketorolac T½ = 150 min, triamcinolone T½ = 88 min). With the longer half-life, ketorolac may have
Conclusion
In this study, a single injection of 60 mg of ketorolac resulted in improvements in outcomes great than a single injection of 40 mg triamcinolone for the treatment of subacromial impingement when assessed at four weeks. While both triamcinolone and ketorolac are effective in the treatment of isolated subacromial impingement, ketorolac appears to have equivalent if not superior efficacy all the while decreasing patient exposure to the potential side-effects of corticosteroids. Immediately
Disclaimer
None of the other authors, their immediate families and any research foundation with which they are affiliated received any financial payments or other benefits from any commercial entity related to the subject of this article.
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This study was reviewed and approved by the Institutional Review Board at Madigan Army Medical Center (US Department of the Army, Combined Meeting of the Clinical Investigation Committee and the Human Use Committee): Study No: 200125.
There was no external sources of funding for this investigation. This study was registered in Clinical Trials, a service of the United States National Institute of Health (clinicaltrials.gov), and the registry identifier is NCT01449448.