The effects of a single-dose subacromial injection of a nonsteroidal anti-inflammatory drug in geriatric patients with subacromial impingement syndrome: a randomized double-blind study

Abstract

Background: As nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids have similar effects, steroids can be avoided to reduce adverse effects. This study aimed to compare the differences in symptom improvement after subacromial injection of steroids or NSAIDs.Methods: Sixty patients with rotator cuff syndrome for at least 3 months were enrolled and divided into steroid and NSAID groups. The steroid group received a mixture of 1 mL of triamcinolone acetonide (40 mg/mL) and 1 mL of lidocaine hydrochloride 2%, while the NSAID group received a mixture of 1 mL of Ketorolac Tromethamine (30 mg/mL) and 1 mL of lidocaine hydrochloride 2%. The patients were assessed before and at 3, 6, and 12 weeks after the procedure. Shoulder scores from visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and University of California Los Angeles (UCLA) were used for evaluation.Results: Both groups showed improvements in the clinical outcomes. Overall VAS, ASES, and UCLA scores improved from 6.9, 32.7, and 16.0 before the procedure to 2.0, 1.2, and 1.1; 81.5, 87.6, and 88.5; and 29.7, 31.8, and 32.0 at weeks 3, 6, and 12 weeks after the procedure, respectively. Twenty-six patients (86.7%) in the steroid group and 28 (93.3%) in the NSAID group reported satisfactory treatment outcomes. There were no significant differences in the outcomes between the two groups (p=0.671).Conclusions: Subacromial injection of NSAIDs for rotator cuff tendinitis with shoulder pain had equivalent outcomes with those of steroid injection at the 12-week follow-up.

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

“…Four studies reported the UCLA as a measure of function as well. Min et al 38 and Kim et al 31 produced ESs in favor of SNIs, large and small, respectively. The papers by Aksakal et al 3 and Yu et al 66 reported ESs for SCIs, moderate and small, respectively (Table 2).…”

“…This could indicate that methylprednisolone is more effective than ketorolac for pain reduction, but less effective for improving function. Meanwhile, in the UCLA analysis, the studies by Min et al 38 and Kim et al 31 also favored SNIs, as seen in the VAS analysis, suggesting that ketorolac is superior to triamcinolone for both pain reduction and improving function. Interestingly, all studies utilizing oxicams 3,30,66 for the CMS or UCLA favored SCIs.…”

“…Eight of the 10 RCTs reported postinjection adverse effects with 6 reporting no cases. Of the remaining 2 studies, 1 (Çift) 17 had 2 patients in the SNI group who experienced temporary hypotension that was not quantified, whereas the other (Kim et al 31 ) had 2 patients in the SCI group who suffered from facial flushing for 1 week. Each patients' symptoms resolved without additional treatment (Table 1).…”

“…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.…”

Short-Term Results of Patients Undergoing Arthroscopic Subacromial Decompression and Acromioplasty

“…The first treatment of patients should be physiotherapy. While there is no significant difference between the results of patients who undergo physiotherapy and surgery, it is reported that patients should undergo absolute physiotherapy before surgical treatment and surgery should be performed with the correct indication (16,17).…”