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Aim: To compare the outcome of subacromial ketorolac injection versus subacromial steroid injection in Shoulder Impingement Syndrome. Methodology: This randomized controlled trial was done at the Department of Orthopedics Unit II, Mayo Hospital, Lahore from 26th April 2018 to 25th October 2018. The sample size was 218patients 15 to 60 years of age with shoulder impingement syndrome, were included and patients with a fracture or rotator cuff tear who presented with weakness and muscle wasting, taking regular systemic NSAIDs or steroids, history ofgastrointestinal (GI) ulcers and bleeding disorderswereexcluded. Randomization was done by lottery method.Group A (ketorolac group) was given a single injection of 60 mg ketorolac mixed with 1 ml 2% lidocaine and Group B (steroid group) was given 40 mg methylprednisolone mixed with 1ml 2% lidocaine. All patients were followed up on 4th weeks. Results: Out of 218 patients, 117(53.67%) were males and 101(46.33%) were females with a male to female ratio of 1.2:1.The mean age of patients in group A was 39.09±9.90years and in group, B was 38.08±8.61years. The mean post-injection VAS score in group A was 2.80±0.94 and in a group, B was 4.20 ± 0.98 with a p-value of <0.001. The mean post-injection constant score in group A was 31.59±6.86 and in group, B was 41.31±4.56 with a p-value of <0.001. Conclusion: Sub-acromial ketorolac injection showeda better mean pain score and constant score than subacromial steroid injection in patients with shoulder impingement syndrome. Keywords: Shoulder Impingement Syndrome, subacromial ketorolac injection, subacromial steroid injection,

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Objective: The objective of this study was to assess the effectiveness of conservative and surgical treatment in cerebral palsy children by evaluating the Medical Research Council (MRC) grading system, modified Ashworth scale, and Barthel Activities of Daily Life (ADL) scale. Method: This prospective case series was performed using a non-probability consecutive sampling technique at the Department of Orthopedic Surgery and Traumatology, King Edward Medical University/Mayo Hospital, Lahore from October 2011 to November 2013. Two hundred children of all ages, having cerebral palsy diagnosed on history and clinical examination were enrolled in the study. Children were treated with conservative and surgical treatment. Pre- and post-treatment, all children were classified based on movement disorder (spastic, athetoid, ataxic, and mixed), parts of the body involved (paraplegic, tetraplegic, diplegic, hemiplegic, monoplegic, double hemiplegic, and triplegic), and gross motor function (GMFCS level I-IV). Their muscle power and tone were assessed using the MRC grading system and modified Ashworth scale, respectively. Assessment of disability and daily function was done by ranking disability grading and Barthel ADL, respectively. The range of motion (ROM) of each joint was assessed clinically. Children were divided based on the treatment method as non-surgical versus surgical treatment. Results: Out of a total of 200 children, the mean age of the children was 7.86±4.17year. There were 134 (67.0%) males and 66 (33.0%) female children. Classification on basis of movement disorder, body part involved, and gross motor function at three-month intervals till twelve months was performed. From the first presentation of children till the last follow-up time period, i.e., 12th month there was no change in the movement disorder (a type of CP, body parts involved, and GMFCS). The final rating of overall treatment results shows that there were 84 (42%) patients who had a poor outcome, and only 35 (17.50%) patients had a fair treatment outcome and 81 (40.50%) patients had good treatment outcomes. Conclusion: The conservative and surgical management showed no effect on movement disorder of the child although, on the final rating scale fair to good treatment outcome was observed in all children. There was an improvement in muscle power grading on the ADL, but no significant improvement was seen on the improvement of type, parts of the body involved, gross motor function classification, modified Ashworth, and ranking disability grading of the children.

BackgroundIn this study, we compared the functional outcome of intra-articular injection of corticosteroid versus platelet-rich plasma (PRP) in patients with frozen shoulder (FS). MethodologyThis randomized controlled trial was conducted in the Department of Orthopedics, Mayo Hospital, Lahore, from January 2018 to December 2018. A total of 202 patients with FS aged 40 to 70 years were included. Patients with medical comorbidities such as chronic liver disease (assessed on history and serum bilirubin >2.0 mg/dl), chronic renal failure (assessed on history and serum creatinine >1.5 mg/dL), and chronic steroid use were excluded. Employing an anterior approach, subjects in groups A and B received one intra-articular injection of 2 mL PRP and 2 mL (80 mg) methylprednisolone acetate, respectively. Age, gender, duration of disease, and pre-injection and post-injection range of motion (ROM) (flexion, extension, abduction, external rotation, and internal rotation) were assessed. The University of California at Los Angeles Shoulder Score (UCLA) and visual analog scale (VAS) scores were measured and compared before and after the injection. All patients were followed at regular intervals post-therapy and the final functional outcome was measured after 12 weeks of therapy. ResultsData were analyzed using SPSS version 20 (IBM Corp., Armonk, NY, USA). A p-value of 0.05 was considered significant when comparing flexion, abduction, external rotation, and internal rotation in both groups using the independent t-test. The ROM in group A (intra-articular PRP) improved significantly (p < 0.05) after injection compared to group B (intra-articular corticosteroid).

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