DOI QR코드

DOI QR Code

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

  • Kim, Youngbea B (Department of Orthopedic Surgery, Veterans Health Service Medical Center) ;
  • Lee, Woo-Seung (Department of Orthopedic Surgery, Veterans Health Service Medical Center) ;
  • Won, Jun-Sung (Department of Orthopedic Surgery, Veterans Health Service Medical Center)
  • Received : 2021.01.25
  • Accepted : 2021.02.16
  • Published : 2021.03.01

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.

Keywords

References

  1. Michener LA, McClure PW, Karduna AR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech (Bristol, Avon) 2003;18:369-79. https://doi.org/10.1016/S0268-0033(03)00047-0
  2. Harrison AK, Flatow EL. Subacromial impingement syndrome. J Am Acad Orthop Surg 2011;19:701-8. https://doi.org/10.5435/00124635-201111000-00006
  3. Koester MC, George MS, Kuhn JE. Shoulder impingement syndrome. Am J Med 2005;118:452-5. https://doi.org/10.1016/j.amjmed.2005.01.040
  4. Cakmak A. Conservative treatment of subacromial impingement syndrome. Acta Orthop Traumatol Turc 2003;37 Suppl 1:112-8.
  5. Cole BJ, Schumacher HR Jr. Injectable corticosteroids in modern practice. J Am Acad Orthop Surg 2005;13:37-46. https://doi.org/10.5435/00124635-200501000-00006
  6. Hiemstra LA, Macdonald PB, Froese W. Subacromial infection following corticosteroid injection. J Shoulder Elbow Surg 2003; 12:91-3. https://doi.org/10.1067/mse.2003.127299
  7. Holt TA, Mant D, Carr A, et al. Corticosteroid injection for shoulder pain: single-blind randomized pilot trial in primary care. Trials 2013;14:425. https://doi.org/10.1186/1745-6215-14-425
  8. van der Windt DA, Koes BW, de Jong BA, Bouter LM. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis 1995;54:959-64. https://doi.org/10.1136/ard.54.12.959
  9. Lee HJ, Kim YS, Ok JH, Lee YK, Ha MY. Effect of a single subacromial prednisolone injection in acute rotator cuff tears in a rat model. Knee Surg Sports Traumatol Arthrosc 2015;23:555-61. https://doi.org/10.1007/s00167-013-2395-1
  10. Ramirez J, Pomes I, Cabrera S, Pomes J, Sanmarti R, Canete JD. Incidence of full-thickness rotator cuff tear after subacromial corticosteroid injection: a 12-week prospective study. Mod Rheumatol 2014;24:667-70. https://doi.org/10.3109/14397595.2013.857798
  11. Stepan JG, London DA, Boyer MI, Calfee RP. Blood glucose levels in diabetic patients following corticosteroid injections into the hand and wrist. J Hand Surg Am 2014;39:706-12. https://doi.org/10.1016/j.jhsa.2014.01.014
  12. Tillander B, Franzen LE, Karlsson MH, Norlin R. Effect of steroid injections on the rotator cuff: an experimental study in rats. J Shoulder Elbow Surg 1999;8:271-4. https://doi.org/10.1016/S1058-2746(99)90141-6
  13. Shams A, El-Sayed M, Gamal O, Ewes W. Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears. Eur J Orthop Surg Traumatol 2016;26:837-42. https://doi.org/10.1007/s00590-016-1826-3
  14. Goyal T, Paul S, Sethy SS, Choudhury AK. Outcomes of ketorolac versus depomedrol infiltrations for subacromial impingement syndrome: a randomized controlled trial. Musculoskelet Surg 2020 May 22 [Epub]. https://doi.org/10.1007/s12306-020- 00667-7.
  15. Elzaher EH, Kotb AM, Hassaan EH. Ultrasound guided injection of platelet enriched plasma versus corticosteroids in patients suffering rotator cuff tendinopathy. QJM 2020;113:hcaa059010. https://doi.org/10.1093/qjmed/hcaa059.010
  16. Dogan N, Erdem AF, Gundogdu C, Kursad H, Kizilkaya M. The effects of ketorolac and morphine on articular cartilage and synovium in the rabbit knee joint. Can J Physiol Pharmacol 2004; 82:502-5. https://doi.org/10.1139/y04-066
  17. Karthikeyan S, Kwong HT, Upadhyay PK, Parsons N, Drew SJ, Griffin D. A double-blind randomised controlled study comparing subacromial injection of tenoxicam or methylprednisolone in patients with subacromial impingement. J Bone Joint Surg Br 2010;92:77-82. https://doi.org/10.2106/JBJS.I.01300
  18. Min KS, St Pierre P, Ryan PM, Marchant BG, Wilson CJ, Arrington ED. A double-blind randomized controlled trial comparing the effects of subacromial injection with corticosteroid versus NSAID in patients with shoulder impingement syndrome. J Shoulder Elbow Surg 2013;22:595-601. https://doi.org/10.1016/j.jse.2012.08.026
  19. Oh JH, Kim SH, Lee HK, Jo KH, Bin SW, Gong HS. Moderate preoperative shoulder stiffness does not alter the clinical outcome of rotator cuff repair with arthroscopic release and manipulation. Arthroscopy 2008;24:983-91. https://doi.org/10.1016/j.arthro.2008.06.007
  20. Jean YH, Wen ZH, Chang YC, et al. Intra-articular injection of the cyclooxygenase-2 inhibitor parecoxib attenuates osteoarthritis progression in anterior cruciate ligament-transected knee in rats: role of excitatory amino acids. Osteoarthritis Cartilage 2007;15:638-45. https://doi.org/10.1016/j.joca.2006.11.008
  21. Pattrick M, Doherty M. Facial flushing after intra-articular injection of steroid. Br Med J (Clin Res Ed) 1987;295:1380. https://doi.org/10.1136/bmj.295.6610.1380
  22. Blair B, Rokito AS, Cuomo F, Jarolem K, Zuckerman JD. Efficacy of injections of corticosteroids for subacromial impingement syndrome. J Bone Joint Surg Am 1996;78:1685-9. https://doi.org/10.2106/00004623-199611000-00007
  23. Almekinders LC, Banes AJ, Ballenger CA. Effects of repetitive motion on human fibroblasts. Med Sci Sports Exerc 1993;25: 603-7