Research

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

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

This article has a correction

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

  1. Ole M Ekeberg, research fellow 1,
  2. Erik Bautz-Holter, professor 1,
  3. Einar K Tveitå, research fellow 1,
  4. Niels G Juel, consultant physician 1,
  5. Synnøve Kvalheim, consultant physician 1,
  6. Jens I Brox, consultant physician23
  1. 1Department of Physical Medicine and Rehabilitation, Ullevål University Hospital and Medical Faculty, University of Oslo, 0407 Oslo, Norway
  2. 2Department of Orthopaedics, Back Surgery and Physical Medicine and Rehabilitation Section, Rikshospitalet University Hospital and Medical Faculty, University of Oslo, 0027 Oslo
  3. 3Unifob Health, University of Bergen, Bergen, Norway
  1. Correspondence to: O M Ekeberg o.m.ekeberg{at}medisin.uio.no
  • Accepted 6 October 2008

Abstract

Objective To compare the effectiveness of ultrasound guided corticosteroid injection in the subacromial bursa with systemic corticosteroid injection in patients with rotator cuff disease.

Design Double blind randomised clinical trial.

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

Patients 106 patients with rotator cuff disease lasting at least three months.

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

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

Results Six weeks after the intervention, the mean difference in improvement in overall shoulder pain and disability index score 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 improvement between groups occurred in favour of the local group for two secondary outcome measures: the Western Ontario rotator cuff index (8.1, 0.7 to 15.6) and change in main complaint (2.0, 0 to 4).

Conclusions No important differences in short term outcomes were found between local ultrasound guided corticosteroid injection and systemic corticosteroid injection in rotator cuff disease.

Trial registration Clinical trials NCT00640575.

Footnotes

  • We thank the employees at the Physical Medicine and Rehabilitation Department at Ullevål University Hospital, Charlotte Begby for help with patients’ logistics, and all the patients who made this study possible.

  • Contributors: All authors participated in the planning of the study and contributed to the protocol. SK was responsible for the injection treatment. OME analysed the data and drafted the manuscript, which were revised by the other authors. All authors approved the final version. OME is the guarantor.

  • Funding: The University of Oslo funded this study.

  • Competing interests: None declared.

  • Ethical approval: The regional ethics committee approved this study. Included patients gave written informed consent.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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