J Korean Orthop Assoc.  2017 Apr;52(2):170-177. 10.4055/jkoa.2017.52.2.170.

Early Clinical Outcomes after Subacromial Injection of Ketorolac in Patients with Shoulder Impingement Syndrome: A Comparison with Steroid Injection

• Kwon J
• Lee YH
• Kim HM
• Kim JM
• Jung HS
• Yi SR

• KMID: 2438982
• DOI: http://doi.org/10.4055/jkoa.2017.52.2.170

Abstract

PURPOSE
The purpose of this study was to compare the clinical results between the subacromial injection of the ketorolac and that of the corticosteroid in patients with subacromial shoulder impingement syndrome.
MATERIALS AND METHODS
Twenty patients with shoulder impingement syndrome received an injection of 60 mg ketorolac and were evaluated in terms of visual analogue scale (VAS), range of motion (ROM) and Constant-Murley score. The outcomes are compared with the data of patients treated by 40 mg triamcinolone injection, retrospectively.
RESULTS
There was no significant difference in the demographics, VAS, ROM, and Constan-Murley score between the two groups before the injection. At the 4 weeks follow-up, pain improvement was significantly greater in the corticosteroid group (2.7±1.53) than in the ketorolac group (4.9±2.08; p=0.001). However 12 weeks after the injection, there was no significant difference in pain improvement between the two groups (ketorolac: 2.9±2.32, corticosteroid: 2.6±1.82; p=0.707). The Constant-Murley score at the final follow-up improved from 33.5 to 52.1 in the corticosteroid group, and from 39.0 to 56.6 in the ketorolac group (p=0.677). ROM was increased in both groups, and external rotation was significantly greater in the ketorolac group than in the corticosteroid group at the final follow-up (ketorolac: 29.3°±9.90°, corticosteroid: 20.8°±7.99°; p=0.005).
CONCLUSION
In this study, ketolorac provided an effect equivalent to triamcinolone in the treatment of subacromial shoulder impingement syndrome at 12 weeks after the injection. This result could offer better opportunities to manage patients with diabetes or local and systemic side effects of repetitive use of corticosteroids.

Keyword

shoulder impingement syndrome; injections; glucocorticoids; non-steroidal anti-inflammatory agents

MeSH Terms

Adrenal Cortex Hormones
Anti-Inflammatory Agents, Non-Steroidal
Demography
Follow-Up Studies
Glucocorticoids
Humans
Ketorolac*
Range of Motion, Articular
Retrospective Studies
Shoulder Impingement Syndrome*
Shoulder*
Triamcinolone
Adrenal Cortex Hormones
Anti-Inflammatory Agents, Non-Steroidal
Glucocorticoids
Ketorolac
Triamcinolone

Figure

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  Figure 1 Differences in pain visual analogue scale (VAS) over time between the two groups.

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  Figure 2 Differences in Constant-Murley score over time between the two groups.

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  Figure 3 Differences in shoulder range of motion over time between the two groups. (A) Forward flexion (FF). (B) External rotation (ER). (C) Internal rotation at back (IR).

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