title: Lornoxicam injection is inferior to betamethasone in the treatment of subacromial impingement syndrome : A prospective randomized study of functional outcomes.
abstract: BACKGROUND
  Subacromial impingement syndrome (SIS) is one of the most frequent shoulder pathologies. Initial treatment is conservative. Subacromial injection of drugs achieves a high concentration at the pathologic site with less drug use and fewer systemic side effects. Glucocorticoids are most frequently injected. One concern with steroid use is the wide array of potential systemic and local complications. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also peripherally acting and can be used locally. Although intraarticular (IA) use of NSAIDs is common in orthopedic practice, it is mostly restricted to the knee joint. Reports of local NSAID for joint pathologies are relatively rare. This study compared the efficacy of single-dose subacromial injections of betamethasone and lornoxicam for treatment of SIS.
  
  
  METHODS
  Subacromial injections of either 7.0 mg betamethasone or 8 mg lornoxicam were received by 70 patients with mean age 53 (46-68) years. Treatment outcome was assessed with Constant-Murley and UCLA questionnaires before injection and at 2‑, 4‑, and 6‑week follow-ups.
  
  
  RESULTS
  The change in outcome scores compared to pretreatment was higher in the steroid group at all follow-ups (p < 0.001). Patients in the steroid group showed a significant improvement at all follow-ups compared to pretreatment (p <0.001) and previous follow-ups (p <0.05) at all times. Patients in the lornoxicam group showed a significant functional improvement in week 2 (p <0.001), which was not evident in the following weeks (p >0.05). Although functional recovery halted after week 2, outcome scores remained significantly higher than the pretreatment values at all weeks (p <0.001).
  
  
  CONCLUSIONS
  Although a single subacromial lornoxicam injection provides rapid functional recovery, which partially extends into the intermediate term, its results are inferior to betamethasone and it may be an alternative only in patients where corticosteroids are contraindicated.
authors.affiliation: Department of Orthopedics and Traumatology, Yüksek İhtisas Teaching and Research Hospital, Bursa, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Aksakal
authors.affiliation: Department of Orthopedics and Traumatology, İstanbul Training and Research Hospital, İstanbul, Turkey. cermutlu@hotmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Ermutlu
authors.affiliation: Faculty of Medicine, Department of Statistics, Uludağ University, Bursa, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Özkaya
authors.affiliation: Department of Orthopedics and Traumatology, Yüksek İhtisas Teaching and Research Hospital, Bursa, Turkey.
authors.forename: Y
authors.initials: Y
authors.lastname: Özkan
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001623:Betamethasone / Q000008:administration & dosage*; D002062:Bursitis / Q000175:diagnosis / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D010894:Piroxicam / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016059:Range of Motion, Articular / Q000187:drug effects*; D020127:Recovery of Function / Q000187:drug effects*; D019534:Shoulder Impingement Syndrome / Q000175:diagnosis* / Q000188:drug therapy*; D052256:Tendinopathy / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D010894:Piroxicam; D001623:Betamethasone; C059451:lornoxicam
keywords: Complications; Nonsteroidal anti-inflammatory drugs; Questionnaires; Shoulder; Steroids