A double-blind randomised controlled study comparing subacromial injection of tenoxicam or methylprednisolone in patients with subacromial impingement

Abstract

We have carried out a prospective double-blind randomised controlled trial to compare the efficacy of a single subacromial injection of the non-steroidal anti-inflammatory drug, tenoxicam, with a single injection of methylprednisolone in patients with subacromial impingement. A total of 58 patients were randomly allocated into two groups. Group A received 40 mg of methylprednisolone and group B 20 mg of tenoxicam as a subacromial injection along with lignocaine. The Constant-Murley shoulder score was used as the primary outcome measure and the Disability of Arm, Shoulder and Hand (DASH) and the Oxford Shoulder Score (OSS) as secondary measures. Six weeks after injection the improvement in the Constant-Murley score was significantly greater in the methylprednisolone group (p = 0.003) than in the tenoxicam group. The improvement in the DASH score was greater in the steroid group and the difference was statistically significant and consistent two (p < 0.01), four (p < 0.01) and six weeks (p < 0.020) after the injection. The improvement in the OSS was consistently greater in the steroid group than in the tenoxicam group. Although the difference was statistically significant at two (p < 0.001) and four (p = 0.003) weeks after the injection, it was not at six weeks (p = 0.055). Subacromial injection of tenoxicam does not offer an equivalent outcome to subacromial injection of corticosteroid at six weeks. Corticosteroid is significantly better than tenoxicam for improving shoulder function in tendonitis of the rotator cuff after six weeks.

Blind or Ultrasound-Guided Corticosteroid Injections and Short-Term Response in Subacromial Impingement Syndrome

“…A prospective, randomized, controlled study comparing subacromial corticosteroid injections with subacromial tenoxicam injections demonstrated a significant improvement in shoulder functions with corticosteroids at 6 wks. 22 Contrary to all of the studies mentioned here, Ekeberg et al 5 reported no important differences in short-term outcomes between local corticosteroid injections and systemic corticosteroid injections in rotator-cuff disease. Vecchio et al 23 reported that the combination of subacromial corticosteroids and local anesthetics was not superior to local anesthetics used alone.…”

Tendinopathy: A Review of the Pathophysiology and Evidence for Treatment

“…33 The final injection study, which compared patient treatment with subacromial steroid injection with a subacromial tenoxicam injection, demonstrated a statistically significant improvement in the steroid-treated patient group as measured by using the Constant Murley Shoulder Score. 34 Three studies compared use of ESWT with other treatments. High-level and low-level ESWT were compared.…”

Comparison of subacromial tenoxicam and steroid injections in the treatment of impingement syndrome

“…Karthikeyan et al [12] compared the efficacy of a single subacromial injection of tenoxicam, with a single injection of methylprednisolone in patients with impingement syndrome. Although tenoxicam injection exerted positive effects, they found significantly greater improvements in the methylprednisolone group.…”