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

Jieun Kwon; Ye Hyun Lee; Hae Min Kim; Jong Min Kim; Hyun Suk Jung; Seung Rim Yi

doi:10.4055/jkoa.2017.52.2.170

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Kwon, Lee, Kim, Kim, Jung, and Yi: Early Clinical Outcomes after Subacromial Injection of Ketorolac in Patients with Shoulder Impingement Syndrome: A Comparison with Steroid Injection

Original Article

J Korean Orthop Assoc 2017;52(2):170-177.

Published online: 1 December 2017

DOI: https://doi.org/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

Jieun Kwon, M.D., Ye Hyun Lee, M.D., Hae Min Kim, M.D., Jong Min Kim, M.D., Hyun Suk Jung, M.D., Seung Rim Yi, Ph.D.

Department of Orthopaedic Surgery, National Police Hospital, Seoul, Korea

Correspondence to: Seung Rim Yi, M.D., Ph.D. Department of Orthopaedic Surgery, National Police Hospital, 123 Songi-ro, Songpa-gu, Seoul 05715, Korea TEL: +82-2-3400-1333 FAX: +82-2-3400-1125 E-mail: nphos@hanmail.net

Received 23 June 2016 Revised 17 August 2016 Accepted 21 September 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: shoulder impingement syndrome, injections, glucocorticoids, non-steroidal anti-inflammatory agents

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Figure 1

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

Figure 2

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

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).

Table 1

Demographics of the Patient Population in This Study

Variable	Total (n=40)	Ketorolac group (n=20)	Corticosteroid group (n=20)	p-value
Age (yr)	55.35 (42–69)	54.45 (46–68)	56.25 (42–69)	0.398
Sex (male)	34 (85.0)	18 (90.0)	16 (80.0)	0.661
Symptom duration (wk)	9.73±20.15	12.20±25.66	7.25±12.72	0.444
Diabetes	14 (35.0)	10 (50.0)	4 (20.0)	0.096
Initial pain visual analogue scale	7.16±1.44	7.10±1.69	7.20±1.20	0.872
Initial Constant score	36.23±9.53	39.00±11.07	33.45±6.38	0.060
Initial forward flexion (°)	130.13±18.83	133.20±19.79	127.00±18.09	0.300
Initial external rotation (°)	18.13±10.36	21.00±10.21	15.30±9.93	0.079
Initial internal rotation (°)^*	14.30±2.30	13.80±2.40	14.90±2.11	0.132
Night pain	23 (57.5)	11 (55.0)	12 (60.0)	0.749

Values are presented as median (range), number (%), or mean±standard deviation.

^* Internal rotation was measured T1=1, T2=2,… T12=12, L1=13… sacrum=17 and thigh=18.

Table 2

Difference between the Two Groups

Variable	Ketorolac group (n=20)	Corticosteroid group (n=20)	p-value
Pain visual analogue scale
Initial	7.1±1.69	7.2±1.20	0.872
1 month follow-up	4.9±2.08	2.7±1.53	0.001
3 months follow-up	2.9±2.32	2.6±1.82	0.707
Constant score
Initial	39.0±11.07	33.5±6.38	0.061
1 month follow-up	47.8±9.04	48.5±7.05	0.786
3 months follow-up	56.6±7.92	52.1±8.33	0.677
Forward flexion (°)
Initial	133.3±19.49	127.0±18.09	0.300
1 month follow-up	137.0±18.45	139.5±12.34	0.617
3 months follow-up	148.0±11.17	144.0±10.46	0.250
External rotation (°)
Initial	21.0±10.21	15.3±9.93	0.079
1 month follow-up	24.3±9.36	18.8±10.75	0.093
3 months follow-up	29.3±9.90	20.8±7.99	0.005
Internal rotation (°)
Initial	13.8±2.40	14.9±2.11	0.132
1 month follow-up	12.1±2.47	13.3±1.97	0.112
3 months follow-up	10.6±2.37	12.0±1.99	0.059

Values are presented as mean±standard deviation.

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