Randomized, double‐blind, placebo‐controlled study of the treatment of the painful shoulder

Abstract

The effect of triamcinolone subacromial bursa injection versus naproxen therapy was compared in a randomized, double-blind , placebo-con trolled study of 100 patients who had painful shoulders. Outcome was compared using degree of active abduction, pain, limitation of function, and a clinical index that combined equally weighted measures of all of these. In a timeadjusted analysis, triamcinolone was superior to placebo in all clinical variables. Naproxen was superior to placebo in all variables except pain. Triamcinolone was superior to naproxen in the relief of pain (P = 0.04) and the clinical index (P = 0.04). Multiple linear regression analysis showed that naproxen and triamcinolone treatment accounted for only 16% of the variation in outcome, compared with 44% accounted for by the clinical index prior to treatment. Thus, patients with a poor pretreatment clinical index (those with the most room for improvement) were least likely to improve. We conclude that both triamcinolone (P = 0.00005) and naproxen (P = 0.02) are superior to placebo in the treatment of the painful shoulder.The painful shoulder is a common, usually temporarily disabling condition secondary to supraspinatus tendinitis and/or subacromial bursitis. There is no proven best treatment for it. Corticosteroid injection into the tendon or bursa, commonly accepted by rheumatologists and orthopedic surgeons to be effective, has not, in past studies, been shown to affect range of motion in the shoulder.In this double-blind, placebo-controlled study, 100 patients were examined to determine the therapeutic effect of an oral nonsteroidal antiinflammatory drug (NSAID; naproxen, 500 mg twice a day) and a local injection of corticosteroid (triamcinolone, 40 mg), alone or in combination. PATIENTS AND METHODS Patients.Of the 100 patients entered into the study, 56 were from the University of California, San Francisco, Screening and Rheumatology Clinics (UCSF) and 44 patients were from the Veterans Administration Emergency and Rheumatology Clinics (VA), San Francisco. Criteria for entry into the study were the presence of at least 2 of the following 3 findings: painful abduction at any degree of motion, painful arc of movement from 45" to 120°, or tenderness over the insertion of the supraspinatus tendon. Biceps tendinitis was not an inclusion criterion. Patients were excluded for any of the following: significant glenohumeral arthritis, a supraspinatus injection during the preceding 3 months, a reason to suspect rotator cuff tear (weakness of arm elevation, a positive "drop arm sign," or a high-riding humerus visible on roentgenogram of the shoulder), contraindication to the use of NSAIDs (e.g., allergy, renal insufficiency, gastritis, or ulcer), or an allergy to lidocaine. No patient demonstrated a "frozen" shoulder, which we

Extracorporeal shock-wave therapy for tendonitis of the rotator cuff

“…26 The patients involved in our study had chronic symptoms. Regression to the mean is unlikely in such patients and has not been noted in other studies of similar populations 4,18,27,28 but it cannot positively be excluded. Spontaneous improvement and significant fluctuation of symptoms would also be unusual in such patients.…”

Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis

“…Two studies used saline as a placebo [47,52] and 11 used lidocaine. Triamcinolone was used in seven trials [1,8,32,37,[44][45][46] (most commonly a single 40-mg dose; range, 10-80 mg). Methylprednisolone was used in six trials, most commonly a 40-mg dose (range, 25-80 mg) [2,4,38,47,51,52].…”

The Effect of Corticosteroid on Collagen Expression in Injured Rotator Cuff Tendon

“…Nonoperative treatment options, including rest, activity modification, nonsteroidal anti-inflammatory medications, physical therapy, and subacromial corticosteroid injections, are all used in the initial management of rotator cuff abnormalities prior to early surgical intervention 3 . Studies have demonstrated clinical improvements in pain relief and range of motion when subacromial corticosteroid injections are used in the treatment of rotator cuff tendinosis [4][5][6] .…”