NHG-Standaard Schouderklachten

Winters, J.C.; Windt, D.A.W.M. van der; Spinnewijn, Wem; Jongh, A C De; Heijden, Geert J. M. G. van der; Buis, Paj; Boeke, A.J.P.; Feleus, Anita; Geraets, Jjxr

doi:10.1007/978-90-313-6614-9_77

Cited by 21 publications

(11 citation statements)

References 64 publications

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“…When this therapy fails, impingement can be treated with subacromial injections. These injections merely consist of a combination of a corticosteroid and a local anesthetic [ 4 , 5 ]. Although it is known that corticosteroids are effective at short term, four to six weeks, only a few studies have investigated the effect of corticosteroids in the first days after injection.…”

Section: Introductionmentioning

confidence: 99%

Subacromial triamcinolone acetonide, hyaluronic acid and saline injections for shoulder pain an RCT investigating the effectiveness in the first days

Penning

Bie

Walenkamp

2014

BMC Musculoskelet Disord

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BackgroundSubacromial impingement is a common cause of shoulder complaints in general practice. When the initial treatment with acetaminophen and low dose Non Steroidal Anti Inflammatory Drugs fails, triamcinolone acetonide injections are commonly used. Triamcinolone acetonide injections are effective at four to six weeks. Little is known about the pain relief effect of triamcinolone acetonide injections in the first days after injection and the effect of repeated injection. In this study we investigate the effect of triamcinolone acetonide injections compared to hyaluronic acid and NaCl injections using a pain diary.Methods159 Patients recruited for an RCT comparing the effect of subacromial injections of triamcinolone acetonide, hyaluronic acid and sodium chloride (NaCl) were used in this study. They were blinded for their treatment and could receive up to three injections. Primary outcome consisted of the patient perceived pain on a VAS score recorded on a daily basis during 21 days following injection. Secondary outcome consisted of the amount of taken escape medication following injection and adverse effects.ResultsAll patients received the first injection. 150 patients also received the second and third injections. 97% Of the paper and pencil pain diaries were returned for data analysis.The triamcinolone acetonide group showed the largest decrease in pain on the VAS scores after injection compared to the hyaluronic acid and NaCl group in the first week after injection. The reduction in pain was best achieved after the first injection, the second triamcinolone acetonide injection showed a further reduction in pain. The third triamcinolone acetonide injection only showed a slight improvement in pain reduction.ConclusionsIn this study we could show a booster effect in pain reduction after repeated triamcinolone acetonide injection. The triamcinolone acetonide group showed a faster reduction in pain after injection compared to the hyaluronic acid and NaCl group. The effect was best seen after the first and second triamcinolone acetonide injection, it is therefore questionable whether it is necessary to repeat triamcinolone acetonide injections more than two times.Trial registrationISRCTN51511455. Registered 20 December 2005Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-352) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Subacromial triamcinolone acetonide, hyaluronic acid and saline injections for shoulder pain an RCT investigating the effectiveness in the first days

Penning

Bie

Walenkamp

2014

BMC Musculoskelet Disord

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“…If conservative physical therapy fails, the patient should be seen by the GP, and treated according to their guidelines. For example, a corticosteroid injection or referral to secondary care might then be indicated (Winters et al, 2008). Even though physical therapy and a corticosteroid injection were as effective in the category 'rotator cuff disorders', a corticosteroid injection was not rated as a first choice of treatment in this study, as corticosteroids were associated with higher adverse event rates.…”

Section: Implications For Clinical Practicementioning

confidence: 75%

“…Differentiating between subgroups relevant to a specific treatment, immediately impacts the therapeutic process (Lord et al, 2011). The Dutch guideline for GPs states physical therapy, corticosteroid injections and surgery are widely used treatment modalities, and besides 'watchful waiting', are advised in patients with various shoulder disorders (Winters et al, 2008). It is important to match these four treatment modalities with diagnostic labels based on evidence of effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Agreement between physical therapists and radiologists of stratifying patients with shoulder pain into new treatment related categories using ultrasound; an exploratory study

Graaf

Ottenheijm

Verhagen

et al. 2019

Musculoskeletal Science and Practice

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Study design: A systematic overview of the literature and an agreement study. Objectives: The aim of this study is to explore the inter-professional agreement of diagnostic musculoskeletal ultrasound (DMUS) between physical therapists (PT) and radiologists, using a new classification strategy based upon the therapeutic consequences in patients with shoulder pain. Background: DMUS is frequently used by PTs, although the agreement regarding traditional diagnostic labels between PTs and radiologists is only fair. Nevertheless, DMUS could be useful when used as a stratifying-tool. Methods: First, a systematic overview of current evidence was performed to assess which traditional diagnostic labels could be recoded into new treatment related categories (referral to secondary care, corticosteroid injections, physical therapy, watchful waiting). Next, kappa values were calculated for these categories between PTs and radiologists. Results: Only three categories were extracted, as none of the traditional diagnostic labels were classified into the 'corticosteroid injection' category. Overall, we found moderate agreement to stratify patients into treatment related categories and substantial agreement for the category 'referral to secondary care'. Both categories 'watchful waiting' and 'indication for physical therapy' showed moderate agreement between the two professions. Conclusion: Our results indicate that the agreement between radiologists and PTs is moderate to substantial when labelling is based on treatment consequences. DMUS might be able to help the PT to guide treatment, especially for the category 'referral to secondary care' as this showed the highest agreement. However, as this is just an explorative study, more research is needed, to validate and assess the consequences of this stratification classification for clinical care.

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“…UC was administered according to the clinical guidelines of the Dutch College of General Practitioners [ 9 ].…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, previous studies showed that therapies aimed at coping with psychosocial determinants are promising interventions to prevent musculoskeletal pain from becoming chronic [ 4 - 8 ]. Up till now, usual care (UC) in patients with shoulder complaints (SCs) in the Netherlands has mainly focused on the biomedical determinants mentioned in the clinical guidelines of the Dutch College of General Practitioners [ 9 ]. Since half of all newly presented episodes of SCs in general practice last for at least six months, a therapy aimed at coping with psychosocial determinants may reduce the proportion of SCs that become chronic [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of an education and activation programme on functional limitations and patient-perceived recovery in acute and sub-acute shoulder complaints – a randomised clinical trial

Bruijn

Bie

Geraets

et al. 2007

BMC Musculoskelet Disord

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BackgroundThe education and activation programme (EAP) aims at coping with psychosocial determinants to prevent the development of chronic shoulder complaints (SCs). The effect of the EAP on functional limitations and patient-perceived recovery after 6 and 26 weeks is evaluated in a randomised clinical trial.MethodsPatients with SCs present at rest or elicited by movement and lasting no longer than 3 months were allocated at random to either EAP as an addition to usual care (UC), or to UC only. Measurements were taken at baseline and after 6 and 26 weeks and were analysed by means of multilevel analysis for the group effect. EAP was administered by GPs or by an ambulant therapist (CDB). Patients in the UC group were given UC by their own GP.ResultsMultilevel analysis failed to show a significant effect of the EAP on either functional limitations or patient-perceived recovery. Analysis showed coincidentally a relation between catastrophising at baseline and functional limitations.ConclusionThe EAP has no significant effect on the outcome of SCs after 6 and 26 weeks. The relation between catastrophising at baseline and functional limitations suggests that an intervention focusing specifically on catastrophising may be more successful in reducing functional limitations in the long term. Further research is however needed to evaluate the effect of catastrophising at baseline on the course of SCs.Trial registrationCurrent Controlled Trials ISRCTN71777817

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NHG-Standaard Schouderklachten

Cited by 21 publications

References 64 publications

Subacromial triamcinolone acetonide, hyaluronic acid and saline injections for shoulder pain an RCT investigating the effectiveness in the first days

Subacromial triamcinolone acetonide, hyaluronic acid and saline injections for shoulder pain an RCT investigating the effectiveness in the first days

Agreement between physical therapists and radiologists of stratifying patients with shoulder pain into new treatment related categories using ultrasound; an exploratory study

Effect of an education and activation programme on functional limitations and patient-perceived recovery in acute and sub-acute shoulder complaints – a randomised clinical trial

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