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Better outcomes seen with NSAIDs for subacromial impingement syndrome

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SAN DIEGO — Subacromial NSAIDs may offer superior shoulder scores, patient satisfaction and flexion strength compared with corticosteroids in the treatment of subacromial impingement syndrome, according to a presenter at the 2011 Annual Meeting of the American Orthopaedic Society for Sports Medicine.

“This is a level 1 study demonstrating that in the treatment of subacromial impingement syndrome at 4 weeks follow-up, patients injected with NSAIDs showed statistically and clinically significant improvement when compared to corticosteroids. This treatment option requires further research and evaluation,” Kyong Su Min, MD, said.

Min and colleagues studied 48 patients with isolated external shoulder impingement syndrome in a double-blinded, randomized controlled clinical trial. Each patient was randomized into either the corticosteroid injection group or NSAIDs injection group. The corticosteroid group received 6 mL of 1% lidocaine with epinephrine and 40 mg triamcinolone, and the NSAIDs group received 6 mL of 1% lidocaine with epinephrine and 60 mg ketorolac. After a single injection, the patients were evaluated and instructed to follow-up in 4 weeks.

Thirty-two patients completed the study, including 17 patients in the NSAIDs group and 15 in the corticosteroid group. Both groups had an increased range of motion and decreased pain. The mean improvement in the UCLA Shoulder Assessment Score at 4 weeks was 7.15 for the NSAIDs group and 2.13 for the corticosteroid group. Patients in the NSAIDs group showed an increase in forward flexion strength and patient satisfaction. Other outcome measures were not statistically significant.

Min also said that there was no reported tissue atrophy with NSAIDs, and NSAIDs were not limited by frequency.

Reference:

• Min KS, Ryan P, Marchant BG, et al. A double-blind randomized controlled trial comparing the effects of subacromial injection with corticosteroid vs. NSAID in patients with shoulder impingement syndrome. Paper #34. Presented at the 2011 Annual Meeting of the American Orthopaedic Society for Sports Medicine. July 7-10. San Diego.
• Disclosure: Min has no relevant financial disclosures.

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