Shoulder Pain – NSAID Injections or Corticosteroid Injections?

/12,721 Comments/in , /by

shoulder painA new study carried out by US researchers has found that NSAID injections are better than corticosteroid injections for relieving shoulder pain. A single injection of the nonsteroidal anti-inflammatory drug (NSAID) ketorolac demonstrated superior pain-relieving qualities compared to corticosteroid injections when treating patients with shoulder impingement syndrome. The study was a double-blind, randomized research project and the paper was recently presented to attendees of the American Orthopaedic Society for Sports Medicine (AOSSM) 2011 Annual Meeting.

Shoulder pain can be caused by a number of conditions, some acute, some chronic, and is often accompanied by neck pain and upper back pain, particularly in conditions such as spinal stenosis, degenerative disc disease and pinched nerves, or even brachial plexus injury. This study looked specifically at subacromial impingement syndrome however, a condition involving trapped tendons when the arm is elevated or the shoulder rotated internally, and which possibly leads to rotator cuff tear if unaddressed. Further problems may also develop, such as impingement of the infraspinatus tendon and biceps tendonitis.


Subacromial impingement syndrome can also be caused by arthritis, with osteophyte growth implicated in some cases. Removal of the osteophytes may be necessary to address the problem, where it is mechanical rather than simply inflammatory in nature. The condition is, however, normally treated with corticosteroid injections and possible physical therapy. Unfortunately, such injections come with a risk of tendon rupture, adverse changes in articular cartilage, and the atrophy of subcutaneous tissue (thinning of the tissue under the skin). During the study, forty-eight patients with isolated external shoulder impingement syndrome were assigned to a group receiving either 6cc of 1% lidocaine with epinephrine and 40mg triamcinolone (the corticosteroid group), or a group receiving the same dose of lidocaine (without the epinephrine) and 60mg ketorolac (the NSAID group). Both groups improved after four weeks in terms of pain and mobility but the NSAID group had a mean improvement of 7.15 compared with 2.13 on the University of California– Los Angeles Shoulder Assessment Score.

NSAID Shots for Shoulder Pain – Risks and Benefits

shoulder pain injectionIn addition, the group receiving NSAID shots for shoulder pain had an increase in strength on forward flexion, whereas the steroid group showed a marginal decrease in strength. Patients in the NSAID group were also more satisfied with their treatment than those receiving steroid shots. The researchers observed that, whilst both groups had initial improvements, only the NSAID group showed significant effects over a longer period of time. Using NSAID injections is preferable to using corticosteroid injections as they do not have the same side-effects of tissue loss, and cartilage damage and may be given more frequently, whereas corticosteroid shots are limited in terms of frequency. There are some potential disadvantages to NSAID shots for shoulder pain however, including complications in patients with kidney dysfunction, and possible bleeding. Taking oral NSAIDs alongside NSAID injections is also advised against, and those with gastric ulcers are not candidates for this treatment as it may exacerbate their condition.

The effect of the NSAID shots at relieving shoulder pain is thought due to the anti-inflammatory action they provide and ketorolac injections have been popular in sports medicine for many years for their ability to reduce pain. Although the study is unlikely to result in a switch from corticosteroid treatment for shoulder pain, or indeed neck pain, it does offer an alternative, particularly in cases where the steroid injections have failed to provide shoulder pain relief.


References

American Orthopaedic Society for Sports Medicine (AOSSM) 2011 Annual Meeting: Abstract 34. Presented July 10, 2011.

12721 replies
  1. tinyurl.com
    tinyurl.com says:

    Unquestionably believe that which you stated. Your favorite reason appeared to be
    on the internet the simplest thing to be aware of.
    I say to you, I certainly get annoyed while people consider worries that they just do not know about.

    You managed to hit the nail upon the top and also defined out
    the whole thing without having side effect , people could take a signal.

    Will likely be back to get more. Thanks

    Reply
  5. tinyurl.com
    tinyurl.com says:

    Wow that was strange. I just wrote an really long comment but after I clicked submit my comment didn’t appear.
    Grrrr… well I’m not writing all that over again. Anyway, just wanted
    to say superb blog!

    Reply
  6. tinyurl.com
    tinyurl.com says:

    Hello there I am so happy I found your webpage,
    I really found you by accident, while I was browsing on Aol for something else, Anyways I am here now and would just
    like to say many thanks for a incredible post and a all round interesting blog (I
    also love the theme/design), I don’t have time to go through it all at the minute but I have book-marked it
    and also added your RSS feeds, so when I have time I will be back to read more, Please do keep up the awesome job.

    Reply
  13. cell phone hackers for hire
    cell phone hackers for hire says:

    I do love the way you have presented this situation and it really does offer me personally a lot of fodder for thought. On the other hand, through just what I have experienced, I really trust when the remarks stack on that individuals stay on issue and don’t start on a tirade associated with some other news of the day. Anyway, thank you for this excellent point and though I do not really go along with the idea in totality, I respect your standpoint.

    Reply
  23. mainland company formation ajman
    mainland company formation ajman says:

    You really make it appear really easy with your presentation however I in finding this topic to be actually something that I feel I might never understand. It sort of feels too complex and very huge for me. I’m having a look forward for your subsequent submit, I’ll try to get the cling of it!

    Reply
  27. zorivareworilon
    zorivareworilon says:

    Normally I do not read article on blogs, however I wish to say that this write-up very pressured me to check out and do it! Your writing taste has been surprised me. Thank you, very nice post.

    Reply
  36. http://tinyurl.com/2myk4v5b
    http://tinyurl.com/2myk4v5b says:

    Definitely imagine that that you stated. Your favourite justification seemed to be at the net the simplest thing to keep in mind of.
    I say to you, I certainly get irked even as people
    think about concerns that they plainly don’t recognise about.
    You managed to hit the nail upon the top and also defined out the
    whole thing without having side effect , folks
    can take a signal. Will likely be back to get
    more. Thanks

    Reply
  47. tinyurl.com
    tinyurl.com says:

    Your style is really unique in comparison to other people
    I’ve read stuff from. Many thanks for posting when you’ve got the opportunity, Guess I’ll just book mark
    this page.

    Reply
  67. http://t.co
    http://t.co says:

    Heya i am for the first time here. I came across this board
    and I find It really useful & it helped me out a lot. I hope to give
    something back and help others like you
    aided me.

    Reply
  69. tinyurl.com
    tinyurl.com says:

    Definitely believe that that you stated. Your favorite justification seemed to be on the net the
    simplest thing to be mindful of. I say to you, I certainly get annoyed whilst people
    think about concerns that they plainly do not recognise about.
    You controlled to hit the nail upon the top as neatly as outlined out the entire thing with
    no need side-effects , other folks could take a signal.
    Will probably be back to get more. Thank you

    Reply
  89. tinyurl.com
    tinyurl.com says:

    Awesome blog! Is your theme custom made or did you download it from somewhere?
    A theme like yours with a few simple adjustements would really make
    my blog stand out. Please let me know where you got your design. With thanks

    Reply
  98. tinyurl.com
    tinyurl.com says:

    Hi, i think that i saw you visited my weblog thus i came to “return the favor”.I’m attempting to find
    things to enhance my website!I suppose its ok to use some of your ideas!!

    Reply
  104. http://tinyurl.com/2ez2zv5m
    http://tinyurl.com/2ez2zv5m says:

    Do you mind if I quote a couple of your posts as long
    as I provide credit and sources back to your website?
    My blog is in the exact same area of interest as yours and my users would certainly benefit from a lot of the information you present here.
    Please let me know if this ok with you. Cheers!

    Reply
  106. 2022
    2022 says:

    Nice blog! Is your theme custom made or did you
    download it from somewhere? A design like yours with a few simple adjustements would really make my blog stand
    out. Please let me know where you got your design. Thanks a lot

    my blog 2022

    Reply
  118. http://tinyurl.com/2z9g7qld
    http://tinyurl.com/2z9g7qld says:

    Hmm it looks like your site ate my first comment (it was super long) so I
    guess I’ll just sum it up what I submitted and say, I’m thoroughly enjoying
    your blog. I as well am an aspiring blog blogger but I’m still new to everything.
    Do you have any helpful hints for novice blog writers? I’d genuinely appreciate it.

    Reply
  144. tracfone
    tracfone says:

    Your style is unique compared to other people I have read stuff from.
    I appreciate you for posting when you have the opportunity, Guess I’ll
    just bookmark this site.

    Feel free to visit my homepage tracfone

    Reply
  147. tinyurl.com
    tinyurl.com says:

    It’s the best time to make some plans for the future and it’s time to be happy.
    I have read this post and if I could I wish to suggest you some interesting things or advice.

    Maybe you could write next articles referring to this article.
    I want to read even more things about it!

    Reply
  155. http://tinyurl.com/
    http://tinyurl.com/ says:

    Have you ever considered publishing an ebook or guest authoring on other sites?

    I have a blog based on the same information you discuss and would really like to have you share some stories/information. I
    know my subscribers would value your work. If you are even remotely interested, feel free to send
    me an e-mail.

    Reply
  492. Ralphcenty
    <