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Is local subacromial corticosteroid injection beneficial in subacromial impingement syndrome?

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Abstract

Subacromial corticosteroid injection is one of the most frequently used management tools in subacromial impingement syndrome (SIS) despite controversial reports on the efficacy. Our purpose, in this single blinded, randomised and controlled study was to clarify whether the corticosteroid injection provides additional benefit when used with other conservative treatment modalities in 48 patients with stage 2 SIS. The patients were randomly divided into three groups according to the two therapeutic injections applied with a 10-day interval: group 1: 10 cc of 1% lignocaine + 40 mg of methylprednisolone for the first and second injections, group 2: 10 cc of 1% lignocaine + 40 mg of methylprednisolone for the first injection and only 10 cc of 1% lignocaine for the second injection, group 3: only 10 cc of 1% lignocaine for the first and second injections. All the patients were prescribed 500 mg of naproxen sodium to use two times daily, instructed to rest and perform Codman’s pendulum exercises during the first 15 days. Shoulder pain during rest, activity, and causing disturbance of sleep was evaluated using a visual analogue scale and shoulder function was investigated by total Constant score and its subsectional parameters which are pain, daily living activities, active range of motion and strength before the therapy and 1 and 3 months after the therapy onset. Significant improvements from the baseline values in all pain and function parameters were observed at the first and second evaluation in all groups. Group 1 patients had more favourably improved values in pain causing sleep disturbance and daily living activity parameters than group 2 and 3 patients only in the 1st month after therapy onset. We found that subacromial corticosteroid injections in the acute or subacute phase of SIS provided additional short-term benefit without any complication when used together with nonsteroidal anti-inflammatory drugs (NSAIDs) and exercise.

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References

  1. Buchbinder R, Green S, Youd JM (2003) Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev 1:CD004016

    PubMed  Google Scholar 

  2. Tallia AF, Cardone DA (2003) Diagnostic and therapeutic injection of the shoulder region. Am Fam Physician 67:1271–1278

    PubMed  Google Scholar 

  3. Neer CS (1983) Impingement lesions. Clin Orthop 173:70–77

    PubMed  Google Scholar 

  4. Fongemie AE, Buss DD, Rolnick SJ (1998) Management of shoulder impingement syndrome and rotator cuff tears. Am Fam Physician 57:667–674, 680–682

    CAS  PubMed  Google Scholar 

  5. Paavola M, Kannus P, Janvinen TA, Jarvinen TL, Jozsa L, Jarvinen M (2002) Treatment of tendon disorders. Is there a role for corticosteroid injection? Foot Ankle Clin 7:501–513

    PubMed  Google Scholar 

  6. Green S, Buchbinder R, Glazier R, Forbes A (1998) Systematic review of randomised controlled trials of interventions for painful shoulder. BMJ 316:354–360

    CAS  PubMed  Google Scholar 

  7. Vecchio PC, Hazleman BL, King RH (1993) A double-blind trial comparing subacromial methylprednisolone and lignocaine in acute rotator cuff tendinitis. Br J Rheumatol 32:743–745

    CAS  PubMed  Google Scholar 

  8. Çalış M, Akgun K, Birtane M, Karacan İ, Çalış H, Tüzün F (2000) Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis 59:44–47

    Google Scholar 

  9. Zlatkin MB, Ianotti JP, Roberts MC, Esterhai JL, Dalinka ML, Kressel HY, Schwartz JS, Lenkinsky LE (1989) Rotator cuff tears: diagnostic performance of MRG imaging. Radiology 172:223–229

    CAS  PubMed  Google Scholar 

  10. Constant CR, Murley AHG (1987) A clinical method of functional assessment of the shoulder. Clin Orthop 21:160–166

    Google Scholar 

  11. Johansson K, Oberg B, Adolfsson L, Foldevi M (2002) A combination of systematic review and clinicians’ beliefs in interventions for subacromial pain. Br J Gen Pract 52:145–152

    PubMed  Google Scholar 

  12. Akpinar S, Hersekli MA, Demirors H, Tandogan RN, Kayaselcuk F (2002) Effects of methylprednisolone and betamethasone injections on the rotator cuff: an experimental study in rats. Adv Ther 19:194–201

    CAS  PubMed  Google Scholar 

  13. Tillander B, Franzen LE, Karlsson MH, Norlin R (1999) Effect of steroid injections on the rotator cuff: an experimental study in rats. J Shoulder Elbow Surg 8:271–274

    Article  CAS  PubMed  Google Scholar 

  14. Blair B, Rokito AS, Cuomo F, Jarolem K, Zuckerman JD (1996) Efficacy of injections of corticosteroids for subacromial impingement syndrome. J Bone Joint Surg Am 78:1685–1689

    CAS  PubMed  Google Scholar 

  15. Esenyel CZ, Esenyel M, Yeşiltepe R, Ayanoğlu S, Bulbul M, Sirvanci M, Kara AN (2003) The correlation between the accuracy of steroid injections and subsequent shoulder pain and function in subacromial impingement syndrome Acta Orthop Traumatol Turc 37:41–45

    Google Scholar 

  16. Khan KM, Cook JL, Bonar F, Harcourt P, Astrom M (1999) Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med 27:393–408

    CAS  PubMed  Google Scholar 

  17. Khan KM, Cook JL, Kannus P, Maffulli N, Bonar SF (2002) Time to abandon the “tendinitis” myth. BMJ 324:626–627

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Murat Birtane.

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Akgün, K., Birtane, M. & Akarırmak, Ü. Is local subacromial corticosteroid injection beneficial in subacromial impingement syndrome?. Clin Rheumatol 23, 496–500 (2004). https://doi.org/10.1007/s10067-004-0930-7

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  • DOI: https://doi.org/10.1007/s10067-004-0930-7

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