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
