Role of Volume in Intra-articular steroid injection for the Treatment of Subacromial Impingement Syndrome in Combined Military Hospital(CMH) Lahore.
AbstractObjective: To find out whether increasing the volume of intra articular steroid injection for the treatment of Subacromial Impingement Syndrome(SIS) causes more pain relief and mobility than conventional small dose injection.
Methods: We conducted this randomized study in Orthopedic Department of CMH Lahore Medical College from December 2018 to February 2019. All patients of subacromial impingement syndrome(SIS) with shoulder pain fulfilling the inclusion criteria were enrolled in this randomized controlled trial. After randomly dividing the patients into two groups, group A patients were administered about 10 ml of 1% Xylocane plus 40 miligram of methylprednisolone in subacromial region wile group B patients were injected 10ml of 1% xylocaine plus 40miligram of methylprednisolone plus 20 ml of normal saline. Pre injection pain in the affected shoulder was assessed in resting state and during activity with the help of Visual Analogue Scale(VAS).Pre injection shoulder motion was documented with the help of a goniometer. Post injection shoulder pain and motion was recorded immediately after the intervention in both groups and subsequently at one month and three months follow up visits.
Results: A total of 100 patients with mean age of 61 years+/- 10.32 SD were equally divided in group A and group B.Post injection pain on VAS decrease by 6 to 8 points in both groups at three months follow up. Range of motion after treatment in Group A was more markedly improved by the end of 3 months than group A, with some patients experiencing almost full range of motion. But no statistically significant difference between the outcome of the two groups was found(P value > 0.05).
Conclusion: The increased volume of intra articular steroid injection for the treatment of Subacromial Impingement Syndrome(SIS) has no significant effect in reducing shoulder pain and range of motion than conventional small volume injection.
2. Umer M, Qadir I, Azam M. Subacromial impingement syndrome. Orthopedic Reviews 2012; 4(2):79-82.
3. Petri M,Neiman R,Whiting-Okeefe Q, Seaman WE.Randomized, double?blind, placebo?controlled study of the treatment of painful shoulder.Arthritis Reheum 1987;30(9):1040-1045.
4. Michener LA, McClure PW, Karduna AR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome.Clinical biomechanics 2003; 18(5): 369-379.
5. Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev.2003;(1):CD004016.
6. 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(11):1685-9.
7. Arroll B, Goodyear-Smith F. Corticosteroid injections for painful shoulder: A meta-analysis.Br J Gen Pract 2005; 55: 224-228.
8. Park SW, Lee HS, Kim JH. The effectiveness of intensive mobilization techniques combined with capsular distension for adhesive capsulitis of the shoulder.J phys Ther Sci 2014; 26(1):1767-1770.
9. Diercks R, Bron C, Dorrestijn O, Meskers C, Naber R, Tjerk de Ruiter et al. Guideline for diagnosis and treatment of subacromial pain syndrome:A multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop. 2014; 85(3): 314–322. doi: 10.3109/17453674.2014.920991.
10. Yoon SH, Lee HY, Lee HJ, Kwack KS. Optimal Dose of Intra-articular Corticosteroids for Adhesive Capsulitis: A Randomized, Triple-Blind, Placebo-Controlled Trial.The American Journal of Sports Medicine 2013;41(5): 1133-1139.
11. Sun Y, Zhang P, Liu S, Li H, Jiang J,Chen S et al.Intra-articular Steroid Injection for Frozen Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis.The American Journal of Sports Medicine 2017;45(9):2171-2179.DOI: https://doi.org/10.1177/0363546516669944.
12. McClure PW, Michener LA, Karduna AR. Shoulder function and 3-dimensional scapular kinematics in people with and without shoulder impingement syndrome. Phys Ther. 2006 ;86(8):1075-90.
13. Dong W, Goost H, Lin X, Burger C, Paul C, Wang Z, et al. Treatments for Shoulder Impingement Syndrome: A PRISMA Systematic Review and Network Meta-Analysis. Medicine (Baltimore). 2015 Mar; 94(10): 510-16 DOI: 10.1097/MD.0000000000000510
14. Haahr J, Ostergaard S, Dalsgaard J, Norup K, Frost P, Lausen S et al. Exercises versus arthroscopic decompression in patients with subacromial impingement: A randomised, controlled study in 90 cases with a one year follow up. Ann Rheum Dis. 2005 ; 64(5): 760-764. DOI: 10.1136/ard.2004.021188.
15. Lewis JS, Wright C, Green A. Subacromial Impingement Syndrome: The Effect of Changing Posture on Shoulder Range of Movement. J Orthop Sports Phys Ther 2005;35(2):72-87.
16. Sauers EL.Effectiveness of rehabilitation for patients with subacromial impingement syndrome. J Athl Train. 2005 ;40(3):221-3.
17. Gundtoft PH, Kristensen AK, Gulaksen BA, Brandslund I, Vobbe JW, Sorensen L. Prevalence of diabetes mellitus in patients with shoulder symptoms is low. Dan Med J. 2013 ;60(10):47-52.
18. Alhashimi RA. Analytical Observational Study of Frozen Shoulder among Patients with Diabetes Mellitus. Joints 2018; 06(03): 141-144.DOI: 10.1055/s-0038-1676105.
19. Amichener LA, Kwalsworth MK, Burnet EN. Effectiveness of rehabilitation for patients with Subacromial impingement syndrome: A systematic review. J Hand Ther 2004;17(2):152-164.DOI:https://doi.org/10.1197/j.jht.2004.02.004.
20. Desmeules F, Cote CH, Fremont P. Therapeutic Exercise and Orthopedic Manual Therapy for Impingement Syndrome: A Systematic Review. Clin J Sport Med 2003;13(3):176-182.
21. Esenyel CZ, Esenyel M, Ye?iltepe R, Ayanoglu S, Bulbul M, Sirvanci M et al.The correlation between the accuracy of steroid injections and subsequent shoulder pain and function in subacromial impingement syndrome. Acta Orthop Traumatol Turc. 2003;37(1):41-5.
22. Min KS, St Pierre P, Ryan PM, Marchant BG, Wilson CJ, Arrington ED. A double-blind randomized controlled trial comparing the effects of subacromial injection with corticosteroid versus NSAID in patients with shoulder impingement syndrome. J Shoulder Elbow Surg. 2013;22(5):595-601.DOI: 10.1016/j.jse.
23. Rizk TE, MD, Gavant ML, Pinals RS. Treatment of Adhesive Capsulitis (Frozen Shoulder) With Arthrographic Capsular Distension and Rupture. Arch Phys Med Rehabil 1994; 75:803-807.
24. Older MW, McIntyre JL, Lloyd GJ. Distension arthrography of the shoulder joint. Canadian Journal of Surgery 1976;19(3):203-210.
25. Paolo C, Haddo O, Levy O,Sforza G. Subacromial impingement syndrome: Management challenges.Orthopedic Research and Reviews 2018;10:83-91. DOI: 10.2147/ORR.S157864.
26. Rangan A, Hanchard N, McDaid C. What is the most effective treatment for frozen shoulder? Bmj 2016; 141-62.DOI:https://doi.org/10.1136/bmj.i4162.
27. Gomoll AH, Katz JN, Warner JJ, Millett PJ. Rotator cuff disorders: recognition and management among patients with shoulder pain. Arthritis Rheum. 2004;50(12):3751-61.