title: Subacromial impingement syndrome: effectiveness of pharmaceutical interventions-nonsteroidal anti-inflammatory drugs, corticosteroid, or other injections: a systematic review.
abstract: OBJECTIVE
  To present an evidence-based overview of the effectiveness of pharmaceutical interventions, including nonsteroidal anti-inflammatory drugs, corticosteroid injections, and other injections, used to treat the subacromial impingement syndrome (SIS). An overview can help physicians select the most appropriate pharmaceutical intervention, and it can identify gaps in scientific knowledge.
  
  
  METHODS
  The Cochrane Library, PubMed, Embase, PEDro, and CINAHL databases.
  
  
  METHODS
  Two reviewers independently selected relevant reviews and randomized clinical trials.
  
  
  METHODS
  Two reviewers independently extracted the data and assessed the methodologic quality.
  
  
  RESULTS
  A best evidence synthesis was used to summarize the results. Three reviews and 5 randomized clinical trials were included. Although we found limited evidence for effectiveness in favor of 2 sessions with corticosteroid injections versus 1 session, for the effectiveness of corticosteroid injections versus placebo, nonsteroidal anti-inflammatory drugs, or acupuncture, only conflicting and no evidence for effectiveness was found. Moderate evidence was found in favor of immediate release oral ibuprofen compared with sustained-released ibuprofen in the short-term. Also, moderate evidence for effectiveness was found in favor of glyceryltrinitrate patches versus placebo patches in the short-term and mid term. Furthermore, injections with disodium ethylene diamine tetraacetic acid plus ultrasound with ethylene diamine tetraacetic acid gel were more effective (moderate evidence) than was placebo treatment in the short- and long-term.
  
  
  CONCLUSIONS
  This article presents an overview of the effectiveness of pharmaceutical interventions for SIS. Some treatments seem to be promising (moderate evidence) to treat SIS, but more research is needed before firm conclusions can be drawn.
authors.affiliation: Department of General Practice, Erasmus MC - University Medical Center, Rotterdam, The Netherlands.
authors.forename: Renske
authors.initials: R
authors.lastname: van der Sande
authors.forename: Willem D
authors.initials: WD
authors.lastname: Rinkel
authors.forename: Lukas
authors.initials: L
authors.lastname: Gebremariam
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Hay
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.forename: Bionka M
authors.initials: BM
authors.lastname: Huisstede
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D002614:Chelating Agents / Q000627:therapeutic use; D004492:Edetic Acid / Q000627:therapeutic use; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D007270:Injections, Intra-Articular; D005996:Nitroglycerin / Q000627:therapeutic use; D019534:Shoulder Impingement Syndrome / Q000188:drug therapy*; D014464:Ultrasonic Therapy; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D002614:Chelating Agents; D014665:Vasodilator Agents; D004492:Edetic Acid; D005996:Nitroglycerin; D007052:Ibuprofen