Subacromial ultrasound guided or systemic steroid injection for rotator cuff disease: randomised double blind study

doi:10.1136/bmj.a3112

Published 23 January 2009, doi:10.1136/bmj.a3112
Cite this as: BMJ 2009;338:a3112

Research

Subacromial ultrasound guided or systemic steroid injection for rotator cuff disease: randomised double blind study

Ole M Ekeberg, research fellow ¹, Erik Bautz-Holter, professor ¹, Einar K Tveitå, research fellow ¹, Niels G Juel, consultant physician ¹, Synnøve Kvalheim, consultant physician ¹, Jens I Brox, consultant physician²^,3

¹ Department of Physical Medicine and Rehabilitation, Ullevål University Hospital and Medical Faculty, University of Oslo, 0407 Oslo, Norway, ² Department of Orthopaedics, Back Surgery and Physical Medicine and Rehabilitation Section, Rikshospitalet University Hospital and Medical Faculty, University of Oslo, 0027 Oslo, ³ Unifob Health, University of Bergen, Bergen, Norway

Correspondence to: O M Ekeberg o.m.ekeberg{at}medisin.uio.no

Objective To compare the effectiveness of ultrasound guidedcorticosteroid injection in the subacromial bursa with systemiccorticosteroid injection in patients with rotator cuff disease.

Design Double blind randomised clinical trial.

Setting Outpatient clinic of a physical medicine and rehabilitationdepartment in Oslo, Norway.

Patients 106 patients with rotator cuff disease lasting at leastthree months.

Interventions Ultrasound guided corticosteroid and lidocaineinjection in the subacromial bursa and lidocaine injection inthe gluteal region (local group); corticosteroid and lidocaineinjection in the gluteal region and ultrasound guided lidocaineinjection in the subacromial bursa (systemic group).

Main outcome measures Difference in improvement in the overallshoulder pain and disability index score after six weeks.

Results Six weeks after the intervention, the mean differencein improvement in overall shoulder pain and disability indexscore between the local group and the systemic group was –5.2(95% confidence interval –13.9 to 3.5); it was –4.1(–12.3 to 4.1, P=0.32) after adjustment for baseline score.A small but statistically significant difference in improvementbetween groups occurred in favour of the local group for twosecondary outcome measures: the Western Ontario rotator cuffindex (8.1, 0.7 to 15.6) and change in main complaint (2.0,0 to 4).

Conclusions No important differences in short term outcomeswere found between local ultrasound guided corticosteroid injectionand systemic corticosteroid injection in rotator cuff disease.

Trial registration Clinical trials NCT00640575 [ClinicalTrials.gov] .

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This article has been cited by other articles:

Ochosi, K. (2009). Simultaneous lidocaine may have confounded results. BMJ 338: b641-b641 [Full text]
Symonds, G. (2009). What is rotator cuff disease anyway?. BMJ 338: b642-b642 [Full text]

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