Comparison of Efficacy of Ketorolac, Triamcinolone and Betamethasone Injections in the Treatment of Shoulder Impingement Syndrome

Abstract

BACKGROUND There is controversial evidence regarding subacromial injections of nonsteroidal anti-inflammatory drugs and corticosteroid providing pain relief and restoration of function in shoulder impingement syndrome. We wanted to assess and compare the efficacy of subacromial ketorolac and steroids injections in treatment of patients with impingement syndrome. METHODS This study was a double-blind randomized controlled trial. The intervention groups included: A) Ketorolac; B) Triamcinolone; C) Betamethasone LA. The patients' pain was recorded based on Visual Analogue Scale system, and performance of patients was recorded based on Oxford Shoulder Score in 0, 2, 4, and 6 weeks. One-way ANOVA, chi-square test and repeated measurement were used to compare and analyse obtained results. RESULTS One hundred five patients were enrolled in the study. Three groups (each one containing 35 patients) were compatible in age and gender. Performance of patients was significantly improved in all three groups over time (p<0.001). The mean pain score of all three groups was significantly decreased over time in the three groups (p<0.001). No significant difference was found for pain scores between the groups at different follow-ups. CONCLUSIONS The results of present study showed that ketorolac, triamcinolone, and betamethasone are equally effective in improving and reducing patients' performance and pain, respectively, in treatment of impingement syndrome.

Nonsteroidal Anti-inflammatory and Corticosteroid Injections for Shoulder Impingement Syndrome: A Systematic Review and Meta-analysis

“…Nine studies were double blinded and 1 was not blinded (Aksakal et al 3 ). Three studies used unclear allocation concealment methods (Çift, 17 Abolhasani et al, 1 Goyal et al 25 ). One study (Aksakal et al 3 ) had a high risk of bias due to a lack of allocation concealment, blinding of the participants and blinding in the outcome assessment (Figure 2).…”

“…The relative potency of many injectable corticosteroids has been determined chemically (Table 4), 36 and based on this measure, each study used an equivalent dose of corticosteroid for their SCI group, despite using different medications. The only exception was in the study of Abolhasani et al, 1 in which 1 of the 2 corticosteroid groups utilized triamcinolone 80 mg, which has double the potency of the other medications. Thus, the results from that cohort were omitted from our analysis.…”

“…Nine studies were double blinded and 1 was not blinded (Aksakal et al 3 ). Three studies used unclear allocation concealment methods (Çift, 17 Abolhasani et al, 1 Goyal et al 25 ).…”

“…51 In addition, SNIs have been shown to cause less gastrointestinal and renal effects than oral NSAIDs in patients with knee arthritis. 22 Several studies have been conducted over the past decade comparing pain relief of SNIs and SCIs in patients with SIS, 1,3,17,25,30,31,38,54,59,66 many of which report similar pain reduction between the 2 approaches. Our primary purpose was to examine the pain relief, functional improvement, and cost of these 2 injections by way of a systematic review and metaanalysis.…”