Methylprednisolone versus triamcinolone in painful shoulder using ultrasound-guided injection

Abstract

There is little evidence about the comparative efficacy of corticosteroids in the treatment of painful shoulder. The main aim was to compare the efficacy of methylprednisolone (MTP) versus triamcinolone (TMC) in the treatment of painful shoulder using an ultrasound-guided injection. Patients with painful shoulder due to subacromial bursitis and partial or full-thickness rotator cuff tears demonstrated by musculoskeletal ultrasound received a guided-injection of MTP acetate 40 mg (12 patients) or TMC acetonide 40 mg (12 patients). Range of motion and pain visual analogue scale were registered at 10 and 30 min, 1 and 2 weeks postinjection. Two weeks postinjection, both groups reported a mean improvement in range of motion (33%) and relief of pain (61%). Relief of pain of 50% or more was observed in 92% of patients in MTP group and 50% of TMC group (p = 0.02). Two months postinjection, 50% of the patients in MTP group and 25% in TMC group reported total relief of pain (p = 0.3). Patients with painful shoulder receiving an ultrasound-guided injection of MTP or TMC have a rapid and sustained overall response. Relief of pain tends to be more rapid with MTP than TMC.

Efficacy of Injected Corticosteroid Type, Dose, and Volume for Pain in Large Joints: A Narrative Review

“…Most studies [28‐42] show small improvements in pain and functional outcomes for several weeks after steroid injection into the subacromial space compared to alternative treatments (physical therapy, oral nonsteroidal anti‐inflammatory drugs, microwave diathermy, lidocaine injection, saline solution) for the treatment of pain and functional disability due to rotator cuff impingement syndrome, whereas several others [43‐49] show no relative difference. In 3 studies that used ultrasound guidance during the subacromial space injection [35,36,42], positive results were observed in the steroid groups compared to the placebo groups.…”

“…Chavez‐Lopez et al [34] compared subacromial space injection of 40 mg methylprednisolone acetate to 40 mg triamcinolone acetonide for the treatment of rotator cuff impingement. At 2 weeks, 92% (95% CI = 62%‐100%) of participants in the methylprednisolone group reported a pain reduction of 50% or greater compared to only 50% (95% CI = 21%‐79%) of the participants in the triamcinolone acetonide group ( P = .02).…”

“…Selection of a type of steroid can be challenging. In the shoulder, early evidence suggests that triamcinolone acetonide may be more beneficial than methylprednisolone acetate for adhesive capsulitis [25], yet methylprednisolone acetate may be more beneficial in the subacromial space for rotator cuff impingement syndrome [34]. In the hip, limited evidence suggests no difference in clinical outcomes among different particulate steroid types used to treat symptomatic femoral acetabular impingement with an associated labral tear [59].…”

Corticosteroid and Local Anesthetic Use Trends for Large Joint and Bursa Injections: Results of a Survey of Sports Medicine Physicians

“…In the present study, most physicians tended to use the same corticosteroid for all injections, regardless of joint location. Triamcinolone and methylprednisolone have been compared directly in a few studies, with similar efficacy reported between triamcinolone acetate and methylprednisolone acetate 22‐26 . Thus physicians may simply choose a single medication for a particular reason (cost, comfort, convenience, formulary, and so on) and continue to use it exclusively.…”

Clinical Guidelines in the Management of Frozen Shoulder: An Update!

“…Steroid injection is certainly superior to PT in reducing pain but evidence is conflicting regarding restoration of ROM while comparing steroid injection with PT or MUA [46]. Furthermore, many issues regarding use of local injectable steroids such as optimal dose [52,53], single or multiple injection, site of injection (intraarticular/subacromial/rotator interval) [54,55], molecule (Triamcinolone/Methylprednisolone) [56][57][58], injection with or without imaging [59] remain contentious and are briefly mentioned in Table 1.…”