title: Subacromial triamcinolone acetonide, hyaluronic acid and saline injections for shoulder pain an RCT investigating the effectiveness in the first days.
abstract: BACKGROUND
  Subacromial impingement is a common cause of shoulder complaints in general practice. When the initial treatment with acetaminophen and low dose Non Steroidal Anti Inflammatory Drugs fails, triamcinolone acetonide injections are commonly used. Triamcinolone acetonide injections are effective at four to six weeks. Little is known about the pain relief effect of triamcinolone acetonide injections in the first days after injection and the effect of repeated injection. In this study we investigate the effect of triamcinolone acetonide injections compared to hyaluronic acid and NaCl injections using a pain diary.
  
  
  METHODS
  159 Patients recruited for an RCT comparing the effect of subacromial injections of triamcinolone acetonide, hyaluronic acid and sodium chloride (NaCl) were used in this study. They were blinded for their treatment and could receive up to three injections. Primary outcome consisted of the patient perceived pain on a VAS score recorded on a daily basis during 21 days following injection. Secondary outcome consisted of the amount of taken escape medication following injection and adverse effects.
  
  
  RESULTS
  All patients received the first injection. 150 patients also received the second and third injections. 97% Of the paper and pencil pain diaries were returned for data analysis.The triamcinolone acetonide group showed the largest decrease in pain on the VAS scores after injection compared to the hyaluronic acid and NaCl group in the first week after injection. The reduction in pain was best achieved after the first injection, the second triamcinolone acetonide injection showed a further reduction in pain. The third triamcinolone acetonide injection only showed a slight improvement in pain reduction.
  
  
  CONCLUSIONS
  In this study we could show a booster effect in pain reduction after repeated triamcinolone acetonide injection. The triamcinolone acetonide group showed a faster reduction in pain after injection compared to the hyaluronic acid and NaCl group. The effect was best seen after the first and second triamcinolone acetonide injection, it is therefore questionable whether it is necessary to repeat triamcinolone acetonide injections more than two times.
  
  
  BACKGROUND
  ISRCTN51511455. Registered 20 December 2005.
authors.affiliation: Department of Orthopaedic Surgery, Maastricht University Medical Centre, P, Debeyeplein 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands. l.penning@maartenskliniek.nl.
authors.forename: Ludo I F
authors.initials: LI
authors.lastname: Penning
authors.forename: Rob A
authors.initials: RA
authors.lastname: de Bie
authors.forename: Geert H I M
authors.initials: GH
authors.lastname: Walenkamp
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D007270:Injections, Intra-Articular; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D019534:Shoulder Impingement Syndrome / Q000150:complications / Q000188:drug therapy; D020069:Shoulder Pain / Q000188:drug therapy* / Q000209:etiology; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000779:Anesthetics, Local; D012965:Sodium Chloride; D006820:Hyaluronic Acid; D008012:Lidocaine; D014222:Triamcinolone Acetonide