Taheri Parisa, Dehghan Farnaz, Mousavi Sahar, Solouki Reza
Department of Physical Medicine and Rehabilitation, Alzahra Training and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
Departement of Internal Medicine, Poursina Hakim Research Institute for Health Care Development, Isfahan, Iran.
J Res Pharm Pract. 2017 Oct-Dec;6(4):223-227. doi: 10.4103/jrpp.JRPP_17_57.
Subacromial impingement syndrome is the most common cause of shoulder pain and restriction in range of motion in the world. The aim of this study was to compare the efficacy of subacromial injection of ketorolac with the injection of corticosteroid for the treatment of subacromial impingement syndrome.
A total of forty patients were randomly allocated into two groups. Group A received 40 mg of methylprednisolone and Group B received 60 mg of ketorolac as a subacromial injection along with lidocaine. Each patient was evaluated in terms of visual analog scale (VAS) for evaluating pain and Constant's score for function evaluation (pain, activity level, and range of motion with standard goniometry). The patients were re-examined 1 and 3 months after intervention. All the patients educated for simple home exercise.
At 1 and 3 months of follow-up, both treatment arms resulted in an increased range of motion and decreased pain. The difference between the groups was not statistically significant ( > 0.05). In ketorolac group, mean pre- and post-treatment (at 12 weeks) VAS scores were 8.6 (range, 3-9) and 4.5 (range 2-4), respectively. In steroid group, mean pre- and post-treatment (at 12 weeks) VAS scores were 8.3 (range, 3-10) and 3.9 (range, 0-7), respectively. The difference was statistically significant within groups at baseline and 1 ( < 0.001) and 3 ( < 0.001) months after the injection.
Subacromial injection of ketorolac has an equivalent outcome to subacromial injection of corticosteroid. The use of ketorolac injections can substantially decrease the pain and increase the range of motion of the shoulder and could be a reasonable alternative in case of corticosteroid contraindications.
肩峰下撞击综合征是全球范围内肩部疼痛和活动受限最常见的原因。本研究的目的是比较肩峰下注射酮咯酸与注射皮质类固醇治疗肩峰下撞击综合征的疗效。
总共40例患者被随机分为两组。A组接受40mg甲泼尼龙，B组接受60mg酮咯酸进行肩峰下注射，同时注射利多卡因。根据视觉模拟量表（VAS）评估疼痛，并根据Constant评分评估功能（疼痛、活动水平以及用标准测角计测量的活动范围）对每位患者进行评估。在干预后1个月和3个月对患者进行复查。所有患者均接受简单的家庭锻炼指导。
在随访1个月和3个月时，两个治疗组的活动范围均增加，疼痛均减轻。两组之间的差异无统计学意义（>0.05）。在酮咯酸组中，治疗前和治疗后（12周时）的VAS平均评分分别为8.6（范围3 - 9）和4.5（范围2 - 4）。在类固醇组中，治疗前和治疗后（12周时）的VAS平均评分分别为8.3（范围3 - 10）和3.9（范围0 - 7）。在注射后基线、1个月（<0.001）和3个月（<0.001）时，组内差异具有统计学意义。
肩峰下注射酮咯酸与肩峰下注射皮质类固醇的疗效相当。使用酮咯酸注射可显著减轻疼痛并增加肩部活动范围，在存在皮质类固醇禁忌证的情况下可能是一种合理的替代方法。
