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European Journal of Orthopaedic Surgery & Traumatology

Erschienen in:

08.02.2018 | Original Article • SHOULDER - CUFF SYNDROME

Short-term outcomes of subacromial injection of combined corticosteroid with low-volume compared to high-volume local anesthetic for rotator cuff impingement syndrome: a randomized controlled non-inferiority trial

verfasst von: Manusak Boonard, Sermsak Sumanont, Alisara Arirachakaran, Punyawat Apiwatanakul, Artit Boonrod, Wichan Kanchanatawan, Jatupon Kongtharvonskul

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 6/2018

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Abstract

Background

In symptomatic tendinosis, a corticosteroid injection into the subacromial space is a palliative treatment option. This study compares high volumes (10 cc) of local anesthetic (LA) combined with triamcinolone acetate (TA) with low volumes (4 cc) of LA combined with TA to see whether the latter would provide similar pain, function and complication outcomes for subacromial injections in patients with impingement syndrome.

Materials and methods

This single-center, randomized, single-blind, non-inferiority trial included patients with shoulder pain and positive multiple clinical tests supporting the diagnosis of impingement syndrome. All 52 patients received subacromial injections, with either high-volume corticosteroid injections (HCI) (10 mL total volume of 1% lidocaine plus 40 mg TA) in 26 patients or low-volume corticosteroid injections (LCI) (4 mL total volume of 1% lidocaine plus 40 mg TA) in 26 patients. The demographic data were reported with the primary outcomes being VAS and WORC scores measured at 30 min, then 2 and 8 weeks after receiving the injections. A non-inferiority margin of 13% was assumed.

Results

Fifty-two patients (26 patients per group) were enrolled in the HCI and LCI. Mean VAS and WORC scores of HCI and LCI at baseline were 6.96, 33.85, 6.81 and 36.54, respectively. The mean VAS measured at 30 min, 2 and 8 weeks was 4.04, 2.08 and 1.20, respectively, in HCI group and 2.65, 1.95 and 1.26, respectively, in LCI group. The mean WORC at 2 and 8 weeks was 67.46 and 81.74, respectively, in HCI group and 65.42 and 80.12 in LCI group. These were not statistically significantly different (P > 0.05 in all).

Conclusion

Corticosteroid injections can be used in the treatment of subacromial impingement syndrome. Low-volume (4 cc) corticosteroid injections have non-inferior pain results for VAS score when compared with high-volume (10 cc) corticosteroid injections.

ClinicalTrials.gov

NCT03120923.

Level of evidence

Level I.

Aksakal M, Ermutlu C, Özkaya G, Özkan Y (2017) Lornoxicam injection is inferior to betamethasone in the treatment of subacromial impingement syndrome: a prospective randomized study of functional outcomes. Orthopade 46(2):179–185. https://doi.org/10.1007/s00132-016-3302-5 CrossRefPubMed

Browning DG, Desai MM (2004) Rotator cuff injuries and treatment. Prim Care 31(4):807–829. https://doi.org/10.1016/j.pop.2004.08.004 CrossRefPubMed

Brox JI, Gjengedal E, Uppheim G, Bohmer AS, Brevik JI, Ljunggren AE, Staff PH (1999) Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome): a prospective, randomized, controlled study in 125 patients with a 2 1/2-year follow-up. J Shoulder Elb Surg 8(2):102–111. https://doi.org/10.1186/1471-2474-15-81 CrossRef

Caldwell JR (1996) Intra-articular corticosteroids. Guide to selection and indications for use. Drugs 52(4):507–514CrossRefPubMed

Carroll MB, Motley SA, Wohlford S, Ramsey BC (2015) Rilonacept in the treatment of subacromial bursitis: a randomized, non-inferiority, unblinded study versus triamcinolone acetonide. Jt Bone Spine 82(6):446–450. https://doi.org/10.1016/j.jbspin.2015.02.009 CrossRef

Chang KV, Hung CY, Wu WT, Han DS, Yang RS, Lin CP (2016) Comparison of the effectiveness of suprascapular nerve block with physical therapy, placebo, and intra-articular injection in management of chronic shoulder pain: a meta-analysis of randomized controlled trials. Arch Phys Med Rehabil 97(8):1366–1380. https://doi.org/10.1016/j.apmr.2015.11.009 CrossRefPubMed

Dogu B, Yucel SD, Sag SY, Bankaoglu M, Kuran B (2012) Blind or ultrasound-guided corticosteroid injections and short-term response in subacromial impingement syndrome: a randomized, double-blind, prospective study. Am J Phys Med Rehabil 91(8):658–665. https://doi.org/10.1097/PHM.0b013e318255978a CrossRefPubMed

Ekeberg OM, Bautz-Holter E, Tveita EK, Juel NG, Kvalheim S, Brox JI (2009) Subacromial ultrasound guided or systemic steroid injection for rotator cuff disease: randomised double blind study. BMJ (Clin Res Ed) 338:a3112. https://doi.org/10.1136/bmj.a3112 CrossRef

Foye PM, Sullivan WJ, Panagos A, Zuhosky JP, Sable AW, Irwin RW (2007) Industrial medicine and acute musculoskeletal rehabilitation. 6. Upper- and lower-limb injections for acute musculoskeletal injuries and injured workers. Arch Phys Med Rehabil 88(3 Suppl 1):S29–S33. https://doi.org/10.1016/j.apmr.2006.12.013 CrossRefPubMed

10.

Gaujoux-Viala C, Dougados M, Gossec L (2009) Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a meta-analysis of randomised controlled trials. Ann Rheum Dis 68(12):1843–1849. https://doi.org/10.1136/ard.2008.099572 CrossRefPubMed

11.

Hong JY, Yoon SH, Moon DJ, Kwack KS, Joen B, Lee HY (2011) Comparison of high- and low-dose corticosteroid in subacromial injection for periarticular shoulder disorder: a randomized, triple-blind, placebo-controlled trial. Arch Phys Med Rehabil 92(12):1951–1960. https://doi.org/10.1016/j.apmr.2011.06.033 CrossRefPubMed

12.

Hsieh LF, Kuo YC, Lee CC, Liu YF, Liu YC, Huang V (2017) Comparison between corticosteroid and lidocaine injection in the treatment of tennis elbow: a randomized, double-blinded, controlled trial. Am J Phys Med Rehabil. https://doi.org/10.1097/phm.0000000000000814 PubMedCrossRef

13.

Jensen MP, Chen C, Brugger AM (2003) Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain Off J Am Pain Soc 4(7):407–414CrossRef

14.

Kang MN, Rizio L, Prybicien M, Middlemas DA, Blacksin MF (2008) The accuracy of subacromial corticosteroid injections: a comparison of multiple methods. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2007.07.010 CrossRefPubMed

15.

Kim DY, Lee JJ, Hwang JT, Lee SS, Nomkhondorj O, Cho MG, Hong MS (2017) Comparison between anterior and posterior approaches for ultrasound-guided glenohumeral steroid injection in primary adhesive capsulitis: a randomized controlled trial. J Clin Rheumatol 23(1):51–57CrossRefPubMed

16.

Koester MC, Dunn WR, Kuhn JE, Spindler KP (2007) The efficacy of subacromial corticosteroid injection in the treatment of rotator cuff disease: a systematic review. J Am Acad Orthop Surg 15(1):3–11CrossRefPubMed

17.

Louis LJ (2008) Musculoskeletal ultrasound intervention: principles and advances. Radiol Clin North Am 46(3):515–533. https://doi.org/10.1016/j.rcl.2008.02.003 vi CrossRefPubMed

18.

Marder RA, Kim SH, Labson JD, Hunter JC (2012) Injection of the subacromial bursa in patients with rotator cuff syndrome: a prospective, randomized study comparing the effectiveness of different routes. J Bone Jt Surg Am 94(16):1442–1447. https://doi.org/10.2106/jbjs.k.00534 CrossRef

19.

McInerney JJ, Dias J, Durham S, Evans A (2003) Randomised controlled trial of single, subacromial injection of methylprednisolone in patients with persistent, post-traumatic impingement of the shoulder. Emerg Med J EMJ 20(3):218–221CrossRefPubMed

20.

Min KS, St. Pierre P, Ryan PM, Marchant BG, Wilson CJ, Arrington ED (2013) A double-blind randomized controlled trial comparing the effects of subacromial injection with corticosteroid versus NSAID in patients with shoulder impingement syndrome. J Shoulder Elbow Surg 22(5):595–601. https://doi.org/10.1016/j.jse.2012.08.026 CrossRefPubMed

21.

Mohamadi A, Chan JJ, Claessen FMAP, Ring D, Chen NC (2017) Corticosteroid injections give small and transient pain relief in rotator cuff tendinosis: a meta-analysis. Clin Orthop Relat Res 475(1):232–243. https://doi.org/10.1007/s11999-016-5002-1 CrossRefPubMed

22.

Naredo E, Cabero F, Beneyto P, Cruz A, Mondejar B, Uson J, Palop MJ, Crespo M (2004) A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder. J Rheumatol 31(2):308–314PubMed

23.

Nejati P, Ghahremaninia A, Naderi F, Gharibzadeh S, Mazaherinezhad A (2017) Treatment of subacromial impingement syndrome: platelet-rich plasma or exercise therapy? A randomized controlled trial. Orthop J Sports Med 5(5):2325967117702366. https://doi.org/10.1177/2325967117702366 CrossRefPubMedPubMedCentral

24.

Porramatikul M, Thaveepunsan S, Sirimanakul S, Wethpiriyakul P et al (2011) Reliability of the Thai version of Western Ontario Rotator Cuff Index. Vajira Med J 55(2):147–156

25.

Randelli P, Randelli F (2014) Regenerative medicine in rotator cuff injuries. BioMed Res Int 2014:129515. https://doi.org/10.1155/2014/129515 CrossRefPubMedPubMedCentral

26.

Rhon DI, Boyles RB, Cleland JA (2014) One-year outcome of subacromial corticosteroid injection compared with manual physical therapy for the management of the unilateral shoulder impingement syndrome: a pragmatic randomized trial. Ann Intern Med 161(3):161–169. https://doi.org/10.7326/m13-2199 CrossRefPubMed

27.

Roddy E, Zwierska I, Hay EM, Jowett S, Lewis M, Stevenson K, van der Windt D, Foster NE (2014) Subacromial impingement syndrome and pain: protocol for a randomised controlled trial of exercise and corticosteroid injection (the SUPPORT trial). BMC Musculoskelet Disord 15:81. https://doi.org/10.1186/1471-2474-15-81 CrossRefPubMedPubMedCentral

28.

Rowbotham MC (2001) What is a “clinically meaningful” reduction in pain? Pain 94(2):131–132CrossRefPubMed

29.

Rutten MJ, Maresch BJ, Jager GJ, de Waal Malefijt MC (2007) Injection of the subacromial-subdeltoid bursa: blind or ultrasound-guided? Acta Orthop 78(2):254–257. https://doi.org/10.1080/17453670710013762 CrossRefPubMed

30.

Sage W, Pickup L, Smith TO, Denton ERE, Toms AP (2013) The clinical and functional outcomes of ultrasound-guided vs landmark-guided injections for adults with shoulder pathology—a systematic review and meta-analysis. Rheumatology (United Kingdom) 52(4):743–751. https://doi.org/10.1093/rheumatology/kes302 CrossRef

31.

Sardelli M, Burks RT (2008) Distances to the subacromial bursa from 3 different injection sites as measured arthroscopically. Arthrosc J Arthrosc Relat Surg 24(9):992–996. https://doi.org/10.1016/j.arthro.2008.04.070 CrossRef

32.

Shin SJ, Lee SY (2013) Efficacies of corticosteroid injection at different sites of the shoulder for the treatment of adhesive capsulitis. J Shoulder Elbow Surg 22(4):521–527. https://doi.org/10.1016/j.jse.2012.06.015 CrossRefPubMed

33.

StataCorp. (2015) Stata statistical software: release 14. StataCorp LP, College Station

34.

Sumanont S, Boonard M, Peradhammanon E, Arirachakaran A, Suwankomonkul P, Oungbumrungpan W, Kongtharvonskul J (2017) Comparative outcomes of combined corticosteroid with low volume compared to high volume of local anesthetic in subacromial injection for impingement syndrome: systematic review and meta-analysis of RCTs. Eur J Orthop Surg Traumatol. https://doi.org/10.1007/s00590-017-2056-z PubMedCrossRef

35.

Todd KH, Funk KG, Funk JP, Bonacci R (1996) Clinical significance of reported changes in pain severity. Ann Emerg Med 27(4):485–489CrossRefPubMed

36.

Ucuncu F, Capkin E, Karkucak M, Ozden G, Cakirbay H, Tosun M, Guler M (2009) A comparison of the effectiveness of landmark-guided injections and ultrasonography guided injections for shoulder pain. Clin J Pain 25(9):786–789. https://doi.org/10.1097/AJP.0b013e3181acb0e4 CrossRefPubMed

37.

Van Der Sande R, Rinkel WD, Gebremariam L, Hay EM, Koes BW, Huisstede BM (2013) Subacromial impingement syndrome: effectiveness of pharmaceutical interventions-nonsteroidal anti-inflammatory drugs, corticosteroid, or other injections: a systematic review. Arch Phys Med Rehabil 94(5):961–976. https://doi.org/10.1016/j.apmr.2012.11.041 CrossRefPubMed

38.

Zheng XQ, Li K, Wei YD, Tie HT, Yi XY, Huang W (2014) Nonsteroidal anti-inflammatory drugs versus corticosteroid for treatment of shoulder pain: a systematic review and meta-analysis. Arch Phys Med Rehabil 95(10):1824–1831. https://doi.org/10.1016/j.apmr.2014.04.024 CrossRefPubMed

Titel: Short-term outcomes of subacromial injection of combined corticosteroid with low-volume compared to high-volume local anesthetic for rotator cuff impingement syndrome: a randomized controlled non-inferiority trial
verfasst von: Manusak Boonard
Sermsak Sumanont
Alisara Arirachakaran
Punyawat Apiwatanakul
Artit Boonrod
Wichan Kanchanatawan
Jatupon Kongtharvonskul
Publikationsdatum: 08.02.2018
Verlag: Springer Paris
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 6/2018
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-018-2149-3

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Abstract

Background

Materials and methods

Results

Conclusion

ClinicalTrials.gov

Level of evidence

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