What is the evidence for corticosteroid injections in the treatment of subacromial impingement syndrome?
AMSTAR Rating
Summary
Patient Population:
There was no patient population information provided.
Intervention:
5 of the 7 trials used a subacromial corticosteroid injection, one trial used an intra-articular injection another trial used a supraspinatus tendon injection.
Comparison:
All 7 trials compared their respective injections to a placebo injection. This review included 3 reviews and an additional 5 RCTs that did not appear in any of those 3 reviews. From within the identified reviews, they included information from 11, 9 and 7 trials on patients diagnosed with subacromial impingement syndrome. 7 trails from the Buchbinder et al. (2003) review examined the use of corticosteroid injections in the treatment of SIS.
Outcome:
- Pain: subacromial corticosteroid injections vs placebo – significant difference in favour of injection (SMD = 0.83; 95% CI 0.39 to 0.26)
- ROM (abduction): subacromial corticosteroid injection vs placebo – significant difference in favour of injection (SMD = 0.63; 95% CI 0.20 to 0.06)
- Function: subacromial corticosteroid injection vs placebo – significant difference in favour of injection (SMD = 0.82; 95% CI 0.39 to 0.25)
- All outcomes were measured at 4 weeks post-procedure.
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Corticosteroid vs. Placebo
Pain
ROM
Function
Relevant Clinical Info
Berry H, Fernandes L, Bloom B, Clark RJ, Hamilton EB. Clinical study comparing acupuncture, physiotherapy, injection and oral anti- inflammatory therapy in shoulder-cuff lesions. Curr Med Res Opin 1980;7:121-6.
- No effect at 4 week follow-up.
Adebajo AO, Nash P, Hazleman BL. A prospective double blind dummy placebo controlled study comparing triamcinolone hex- acetonide injection with oral diclofenac 50 mg TDS in patients with rotator cuff tendinitis. J Rheumatol 1990;17:1207-10.
- Improved pain, ROM, and function at 4 week follow-up.
Petri M, Dobrow R, Neiman R, Whiting-O’Keefe Q, Seaman WE. Randomized, double-blind, placebo-controlled study of the treatment of the painful shoulder. Arthritis Rheum 1987;30:1040-5.
- Improved pain, ROM, and function at 4 week follow-up.
Blair B, Rokito AS, Cuomo F, Jarolem K, Zuckerman JD. Efficacy of injections of corticosteroids for subacromial impingement syndrome. J Bone Joint Surg Am 1996;78:1685-9.
- Improved pain at 33 weeks. Improved ROM at 28 weeks.
