Use of local corticosteroid injections in supraspinatus tendinitis
Date First Published:
August 10, 2000
Last Updated:
June 8, 2005
Report by:
Walid Alsalim, Specialist Registrar in Emergency Medicine (Ipswich Hospital)
Search checked by:
Liz Allen, Ipswich Hospital
Three-Part Question:
In [patients presenting with supraspinatus tendinitis] does [local steroid injection] [relieve pain and reduce time to recovery]
Clinical Scenario:
A 56 year old lady present in Emergency Department with a history of severe pain in his right shoulder following a busy day working in his garden. She had pain on resisted abduction and tenderness over supraspinatus tendon.
Search Strategy:
Medline 1951-May 2005 using dialog (datastar)
Search Details:
[supraspinatus or tendonitis] AND [glucocorticoids#.W.DE. or methylprednisolone#.W.DE. or triamcinolone acetonide#.W.DE] AND [injection$]
Outcome:
45 papers were identified of which 3 were relevant and formed the subject of this review.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Subacromial Triamcinolone Hexacetonide and Methylprednisolone Injections in Treatment of Supraspinam Tendinitis. Valtonen EJ. 1976 Finland | 60 patients in outpatient (Rheumatology clinic) with supraspinatus tendonitis Comparing triamcinolon acetonide versus methyl-Prednisolone |
Clinical trial | Pain at 8 weeks | Triam. 3.83 to 1.41 p 0.001. Methyl 3.77 to 1.55 p 0.001. Triam 50% vs mthyl 41% NS between two drugs in reducing pain. | No randomisation No power calculation Not blinded Not in ED setting Side effects: Triam was more painful than methylprednisolone 33% triam required 2nd injection versus 63% in meth. Arm. |
| Localised tenderness at 8 weeks | Triam 3.30 to 0.96 p 0.001. Methyl 3.17 to 0.45 p 0.01. Triam 29% vs methyl 14%. NS between two drugs. | ||||
| Limitation of motion | Triam 2.90 to 0.78 p 0.001. Methyl 3.13 to 0.85 p 0.001. Triam 27% vs 27%. NS between two drugs. | ||||
| Disturbance of sleep | Triam 3.33 to 1.17 p 0.001. Methyl 3.37 to 1.20 p 0.001. Triam 35% vs methyl 36%. NS between two drugs. | ||||
| Double Acting Betamethasone (Celestone Chonodose) in the Treatment of Supraspinatus Tendinitis. Valtonen EJ. 1978 Finland | 180patients A- 90 pts received local injection of 6 mg betamethasone B- 60 pts intramuscular 6 mg betamethasone C- 30 pts received IM saline Comparing subacromial and gluteal single injection with placebo |
Clinical trial | Pain relief, functional improvement at 1, 2, 4 weeks. Diff A-B | At (1) week: NS. At (2) week: NS. At (4) week: NS. | Not randomised Not powered Loss of follow up |
| Diff A-C | At (1) week: 0.01<p<0.02. At (2) week: 0.01<p<0.05. At (4)week:NS. | ||||
| A Placebo-Controlled Trial of Steroid Injections in the Treatment of Supraspinatus Tendonitis. Withrington R H, Girgis F L, Seifert M H. 1985 England | 25 pts Rheumatology clinic Group 1 -12 pts received local injection of 80 mg (2ml) methyl prednisolone plus 2ml of 2% lignocaine. Group 2 -13 pts received 4 mls of 0.09% Nacl |
Clinical trial | Shoulder movements and pain assessment at presentation 2 weeks and 8 weeks. Group 1. | 7 pts responded at (2) weeks (two relapsed at 8 weeks). Mean improvements in VAS of 3.71 cm between (0) and (20 weeks) P > 0.05 | Small trial Not powered Placebo vs methylpred. and local effect |
| Group 2. | 4 pts responded at (2) weeks (1 pt relapsed at 8 weeks). Mean improvement in VAS of 1.16 cm at (0) and (2) weeks. P > 0.05 |
Author Commentary:
Only three studies were found of which all go back to mid-seventies. They were of low quality to produce evidence supporting this clinical practice.
Bottom Line:
Local hospital policy to be followed regarding the treatment of this clinical condition.
References:
- Valtonen EJ.. Subacromial Triamcinolone Hexacetonide and Methylprednisolone Injections in Treatment of Supraspinam Tendinitis.
- Valtonen EJ.. Double Acting Betamethasone (Celestone Chonodose) in the Treatment of Supraspinatus Tendinitis.
- Withrington R H, Girgis F L, Seifert M H.. A Placebo-Controlled Trial of Steroid Injections in the Treatment of Supraspinatus Tendonitis.