Subacromial Injection With Corticosteroid Versus Nonsteroidal Anti-inflammatory Drugs (NSAID) in Shoulder Impingement Syndrome

Study Overview
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Brief Summary
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Injection with corticosteroid is one of the most common non-operative interventions in the treatment of subacromial impingement; however, its use is limited by its potential side effects (e.g. tendon rupture, subcutaneous atrophy, articular cartilage changes). The objective of this study was to compare the efficacy of subacromial injection of triamcinolone compared to injection of ketorolac. Thirty-two patients diagnosed with external shoulder impingement syndrome were included in this double-blinded randomized controlled clinical trial. Each patient was randomized into the Steroid group or NSAID group.

Detailed Description
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After a single injection into the subacromial space, the patients were instructed to perform home physical therapy and follow-up in four weeks. Each patient was evaluated in terms of arc of motion, Visual Analog Scale and the UCLA Shoulder Rating Scale. The outcome measures were taken at the preinjection state, immediately post injection, and at 4 weeks follow-up.

Official Title
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A Double-blind Randomized Controlled Trial Comparing the Effects of Subacromial Injection With Corticosteroid Versus NSAID in Patients With Shoulder Impingement Syndrome

Conditions
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Subacromial Impingement Syndrome, Subacromial Bursitis

Intervention / Treatment
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* Drug: Ketorolac
* Drug: Triamcinolone


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Shoulder pain characteristic of subacromial impingement syndrome with passive and/or active abduction in the 60-120 arc of motion (positive impingement sign) Diagnosis of subacromial bursitis based on tenderness to palpation anterior/lateral to the acromion. Pain may be exacerbated with the shoulder held in internal rotation (positive Hawkins test) Exclusion Criteria: Age <18 years Symptoms less than one month Previous shoulder injections within the past 3 months Evidence of os-acromiale or other confounding shoulder pathology on plain radiographs Evidence of shoulder osteoarthritis Full thickness rotator cuff tear evidenced by MRI, cuff weakness after lidocaine injection, or positive drop-arm sign Systemic inflammatory condition Pending litigation or work-related claims related to the shoulder Previous shoulder surgery on the affected shoulder Evidence of local infection Evidence of adhesive capsulitis Previous history of gastrointestinal ulcers or bleeding disorders Evidence of shoulder instability

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: NSAID<br>Test Group: This group was given subacromial injections of Ketorolac. | Drug: Ketorolac<br>* Subacromial injection<br>|
| Active Comparator: Steroid<br>This group was given a subacromial injection triamcinolone. | Drug: Triamcinolone<br>* Subacromial Injection<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| UCLA Shoulder Rating Scale | This scoring system consists of subjective assessments of pain, function and satisfaction, as well as objective measurements of active forward elevation and strength in forward flexion. | 4 Weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Analog Scale | This is a pain scale. | 4 Weeks | 
| Range of Motion | Shoulder Range of Motion was assessed with a hand held goniometer | 4 Weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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pain relief, Hypermobility, Joint, increased strength, increased patient satisfaction