Subacromial Ketorolac is beneficial in patients with Rotator cuff Tendinitis

A double blind randomized controlled trial comparing the effects of subacromial injection with corticosteroid versus NSAID in patients with shoulder impingement syndrome.

Min KS, St Pierre P, Ryan PM, Marchant BG, Wilson CJ, Arrington ED.

Source

Department of Surgery, Orthopaedic Service, Madigan Healthcare System, Tacoma, WA, USA

J Shoulder Elbow Surg. 2013 May;22(5):595-601. doi: 10.1016/j.jse.2012.08.026. Epub 2012 Nov 22.

 

Subacromial impingement syndrome is a common problem presenting to the outpatient department. Traditionally,   analgesics, physiotherapy and subacromial corticosteroid injection have been used to improve shoulder pain and function. In this study by MIN KS et al.. he compared the use of sub acromial injection of NSAID Vs triamcinolone

Population

48 patients with shoulder pain and with sub acromial bursitis with +ve  Neer sign and Hawkin sign

Intervention,

24 patients:NSAID group-60 mg ketorolac combined with 6cc  of 1% lignocaine and epinephrine.

Comparison

Steroid group-24 patients received 40mg triamcinolone along with 6 cc of 1 % lignocaine and epinephrine.

Outcomes

• Primary outcome measurement was the the University of California at los angeles(UCLA) shoulder rating scale.
• Secondary outcome measurement were ,pain measured using visual analog scale, active and passive range of motions in abduction and forward flexion measured using a goniometer.

Methods

Double blinded RCT

RESULTS

• At 4 weeks NSAID group had significantly higher UCLA scores compared to steroid group(7.5 Vs 2.13)
• VAS pain scores were higher in the NSAID group but was not significant
• Siginifacnt increase in passive abduction in the NSAID group(21.76) compared to (-3.33) in the steroid group

Conclusion and Summary:

• Subacromial injection of Ketorolac improved the UCLA shoulder scores, and passive abduction compared to steroid injection.
• Ketorolac maybe considered a viable alternative to steroids as it avoids the complications associated with steroids.

Ref:

1.http://www.jshoulderelbow.org/article/S1058-2746%2812%2900372-2/fulltext