Subacromial Bursitis, Subacromial Impingement Syndrome
Conditions
Keywords
pain relief, Hypermobility, Joint, increased strength, increased patient satisfaction
Brief summary
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
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.
Interventions
DRUGKetorolac
Subacromial injection
DRUGTriamcinolone
Subacromial Injection
Sponsors
Madigan Army Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
1. Shoulder pain characteristic of subacromial impingement syndrome with passive and/or active abduction in the 60-120 arc of motion (positive impingement sign) 2. 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
1. Age \<18 years 2. Symptoms less than one month 3. Previous shoulder injections within the past 3 months 4. Evidence of os-acromiale or other confounding shoulder pathology on plain radiographs 5. Evidence of shoulder osteoarthritis 6. Full thickness rotator cuff tear evidenced by MRI, cuff weakness after lidocaine injection, or positive drop-arm sign 7. Systemic inflammatory condition 8. Pending litigation or work-related claims related to the shoulder 9. Previous shoulder surgery on the affected shoulder 10. Evidence of local infection 11. Evidence of adhesive capsulitis 12. Previous history of gastrointestinal ulcers or bleeding disorders 13. Evidence of shoulder instability
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| UCLA Shoulder Rating Scale | 4 Weeks | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Visual Analog Scale | 4 Weeks | This is a pain scale. |
| Range of Motion | 4 Weeks | Shoulder Range of Motion was assessed with a hand held goniometer |
Outcome results
None listed