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From: [email protected] [mailto:[email protected]] On Behalf Of Équipe éditoriale de amc.ca Sent: 23 avril 2009 04:00 To: [email protected] Subject: InfoPOEM: Bursa injection no better than systemic steroid for rotator cuff Pour assurer la livraison de ce courriel dans votre boîte de réception, veuillez ajouter [email protected] <mailto:[email protected]> à votre carnet de contacts. <http://www.cma.ca/multimedia/CMA/NewsLetters/InfoPOEMs/French/Header.jpg> Bursa injection no better than systemic steroid for rotator cuff Clinical question Is shoulder injection of a corticosteroid more effective than systemic steroid therapy in patients with rotator cuff disease? Bottom line Subacromial bursa injection, even under ultrasound guidance, provides no better pain and movement relief than an injection of the same amount of corticosteroid (20 mg triamcinolone) into the upper gluteal region. Since all patients received both a gluteal and shoulder injection, there is the possibility of an additional placebo effect of an injection "where it hurts." (LOE = <http://mailer.cma.ca/t/4156909/234493/102001/0/> 1b-) Reference Ekeberg OM, Bautz-Holter E, Tveit¿K, Juel <http://mailer.cma.ca/t/4156909/234493/5040473/0/> NG, Kvalheim S, Brox JI. Subacromial ultrasound guided or systemic steroid injection for rotator cuff disease: randomised double blind study. BMJ 2009;338:a3112. Study design Randomized controlled trial (double-blinded) Funding Self-funded or unfunded Allocation Concealed Setting Outpatient (primary care) <http://www.cma.ca/multimedia/CMA/NewsLetters/InfoPOEMs/Bullet.gif> Obtenez <http://mailer.cma.ca/t/4156909/234493/5040725/0/> des crédits Mainpro <http://www.cma.ca/multimedia/CMA/NewsLetters/InfoPOEMs/Bullet.gif> Discutez <http://mailer.cma.ca/t/4156909/234493/5040475/0/> de cet InfoPOEM <http://www.cma.ca/multimedia/CMA/NewsLetters/InfoPOEMs/Bullet.gif> Archives <http://mailer.cma.ca/t/4156909/234493/145011/0/> <http://www.cma.ca/multimedia/CMA/NewsLetters/InfoPOEMs/Bullet.gif> Bilan <http://mailer.cma.ca/t/4156909/234493/177011/0/> des crédits <http://www.cma.ca/multimedia/CMA/NewsLetters/InfoPOEMs/Bullet.gif> Plus <http://mailer.cma.ca/t/4156909/234493/3021/0/> de FMC / DPC <http://mailer.cma.ca/t/4156909/234493/45002/0/> Publicité <http://www.cma.ca/multimedia/CMA/NewsLetters/InfoPOEMs/Book.gif> Bibliothécaire <http://mailer.cma.ca/t/4156909/234493/147004/0/> de l'AMC <http://www.cma.ca/multimedia/CMA/NewsLetters/InfoPOEMs/Envelop.gif> Envoyez-nous vos <mailto:[email protected]> commentaires Synopsis To determine the effectiveness of a subacromial bursa injection of corticosteroid, these Norwegian investigators recruited 106 patients from general practices with rotator cuff pain lasting at least 3 months, though 39% had pain duration of at least 1 year. They enrolled patients with pain on 2 of 3 tests of abduction, external rotation, and external rotation less than a 50% decrease in range of motion, and a positive Hawkins-Kennedy impingement sign. The patients were randomly assigned (allocation concealed) to receive either local or systemic therapy. Local treatment consisted of ultrasound-guided injection of the bursa with 20 mg of triamcinolone and 50 mg lidocaine; systemic treatment consisted of 20 mg triamcinolone and 20 mg lidocaine to the upper gluteal region. To mask patients and outcome assessors, patients receiving local injection also received a gluteal injection of lidocaine, and systemically treated patients also received an ultrasound-guided bursa injection of lidocaine only. Analyzed by intention to treat, the main outcome was the improvement in a shoulder pain and disability index from a baseline of 52 (of a possible 100). The scores at 2 weeks and 6 weeks after treatment improved significantly in both groups, but were not significantly different between the 2 groups. On the scale used in this study, a clinical improvement is at least 13.2, which occurred in both groups. 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