Comparison of high- and low-dose corticosteroid in subacromial injection for periarticular shoulder disorder: a randomized, triple-blind, placebo-controlled trial.
OBJECTIVE
To determine whether subacromial injection with high-dose corticosteroid in patients with periarticular shoulder disorders is better than low-dose corticosteroid or placebo in improving pain, function, and active range of motion (AROM).


METHODS
Multicenter, randomized, triple-blind, placebo-controlled trial.


METHODS
Primary (n=2) and university-affiliated (n=1) tertiary-care hospitals.


METHODS
Volunteers (N=79) with periarticular shoulder disorders with at least 1 month's duration of pain.


METHODS
Participants were randomly assigned to receive ultrasound-guided subacromial injection with triamcinolone acetonide, 40 or 20mg, or placebo. After a single injection, participants were followed up for 8 weeks.


METHODS
Visual analog scale (VAS) of average shoulder pain level during the past 1 week, Shoulder Disability Questionnaire (SDQ), and angles of shoulder AROM (including flexion, abduction, external rotation, internal rotation) pre- and posttreatment at weeks 2, 4, and 8.


RESULTS
There were no significant differences among the 3 groups (triamcinolone acetonide, 40mg, group 1, n=27; triamcinolone acetonide, 20mg, group 2, n=25; placebo, group 3, n=27) in terms of demographic and clinical characteristics at baseline. (1) Within-group comparison: VAS score, SDQ score, and AROM for groups 1 and 2 significantly improved at weeks 2, 4, and 8 (P<.0167). However, there was no difference in VAS score, SDQ score, and AROM scores for group 3. (2) Between-group comparison: significant differences in VAS score, SDQ score, and abduction, external rotation, and internal rotation of AROM were shown between groups 1 and 2 and group 3 at weeks 2, 4, and 8 (P<.05).


CONCLUSIONS
This was the first study to assess the efficacy of corticosteroid according to 2 different doses, which are the most widely used in subacromial injection for participants with periarticular shoulder disorders. This study showed no significant differences between the high- (triamcinolone acetonide, 40mg) and low-dose (20mg) corticosteroid groups, indicating preferred use of a low dose at the initial stage.
Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Republic of Korea.
Ji Yeon
JY
Hong
Seung-Hyun
SH
Yoon
Do Jun
DJ
Moon
Kyu-Sung
KS
Kwack
Bohyun
B
Joen
Hyun Young
HY
Lee
D005081:Exercise Therapy; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods; D010147:Pain Measurement; D016059:Range of Motion, Articular / Q000187:drug effects; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology*; D020069:Shoulder Pain / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D014463:Ultrasonography
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide