Comparison of Subacromial Ketorolac Inj Vs Subacromial Steroid Inj in Shoulder Impingement Syndrome

Abstract

Aim: To compare the outcome of subacromial ketorolac injection versus subacromial steroid injection in Shoulder Impingement Syndrome. Methodology: This randomized controlled trial was done at the Department of Orthopedics Unit II, Mayo Hospital, Lahore from 26th April 2018 to 25th October 2018. The sample size was 218patients 15 to 60 years of age with shoulder impingement syndrome, were included and patients with a fracture or rotator cuff tear who presented with weakness and muscle wasting, taking regular systemic NSAIDs or steroids, history ofgastrointestinal (GI) ulcers and bleeding disorderswereexcluded. Randomization was done by lottery method.Group A (ketorolac group) was given a single injection of 60 mg ketorolac mixed with 1 ml 2% lidocaine and Group B (steroid group) was given 40 mg methylprednisolone mixed with 1ml 2% lidocaine. All patients were followed up on 4th weeks. Results: Out of 218 patients, 117(53.67%) were males and 101(46.33%) were females with a male to female ratio of 1.2:1.The mean age of patients in group A was 39.09±9.90years and in group, B was 38.08±8.61years. The mean post-injection VAS score in group A was 2.80±0.94 and in a group, B was 4.20 ± 0.98 with a p-value of <0.001. The mean post-injection constant score in group A was 31.59±6.86 and in group, B was 41.31±4.56 with a p-value of <0.001. Conclusion: Sub-acromial ketorolac injection showeda better mean pain score and constant score than subacromial steroid injection in patients with shoulder impingement syndrome. Keywords: Shoulder Impingement Syndrome, subacromial ketorolac injection, subacromial steroid injection,

Nonsteroidal Anti-inflammatory and Corticosteroid Injections for Shoulder Impingement Syndrome: A Systematic Review and Meta-analysis

“…Small ESs favoring SNIs were seen in Kim et al 31 and Min et al, 38 which compared ketorolac with triamcinolone. Two (Taheri et al, 59 Goyal et al 25 ) of the 3 studies that compared ketorolac 60 mg with methylprednisolone 40 mg produced ESs favoring SCIs, small and large, respectively, whereas the other (Siddique et al 54 ) produced a moderate ES for SNIs. A large ES for SNIs was seen in Çift, 17 which compared tenoxicam with methylprednisolone.…”

“…64 Our meta-analyses of both the CMS and UCLA data produced ESs that were small toward NSAIDs, but with high P values (0.71 and 0.79); therefore, the results are clinically and statistically insignificant. The study by Siddique et al 54 was explored as a possible outlier in both analyses. However, no potential sources of bias were determined by Cochrane analysis, and it was the most robust study, having the largest number of participants.…”

“…One resulted in a large ES, whereas the other 3 were small. The studies by Taheri et al 59 and Siddique et al 54 reported ESs favoring NSAIDs, small and large, respectively. The studies by Karthikeyan et al, 30 which utilized tenoxicam 20 mg and methylprednisolone 40 mg, and Aksakal et al, 3 which compared lornoxicam with betamethasone, demonstrated small ESs for SCIs (Table 2).…”

“…A slight asymmetric distribution toward positive Cohen d is seen within the VAS analysis, whereas symmetry is seen within the CMS and UCLA funnel plots. In addition, 2 studies (Siddique et al, 54 Goyal et al 25 ) for the VAS, 2 for the CMS (Siddique et al, 54 Karthikeyan et al 30 ), and 2 (Aksalkal et al, 3 Min et al 38 ) for the UCLA were outside the 95% pseudo CI. However, for each scale, 1 was left of the negative margin and the other right of the positive margin (Figure 5).…”

“…51 In addition, SNIs have been shown to cause less gastrointestinal and renal effects than oral NSAIDs in patients with knee arthritis. 22 Several studies have been conducted over the past decade comparing pain relief of SNIs and SCIs in patients with SIS, 1,3,17,25,30,31,38,54,59,66 many of which report similar pain reduction between the 2 approaches. Our primary purpose was to examine the pain relief, functional improvement, and cost of these 2 injections by way of a systematic review and metaanalysis.…”