CMA NewsletterBon à savoir: efficacité égale pour les habiles et les moins habiles... Dominic ----- Original Message ----- From: Alain Vadeboncoeur To: [email protected] Sent: Thursday, April 23, 2009 10:59 AM Subject: URG-L: FW: InfoPOEM: Bursa injection no better than systemic steroid for rotator cuff
------------------------------------------------------------------------------ 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] à votre carnet de contacts. 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 = 1b-) Reference Ekeberg OM, Bautz-Holter E, Tveit¿K, Juel 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) Obtenez des crédits Mainpro Discutez de cet InfoPOEM Archives Bilan des crédits Plus de FMC / DPC Publicité Bibliothécaire de l'AMC Envoyez-nous vos 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. Discutez de cet InfoPOEM Archives InfoPOEMs (contenu anglais) | CLIPs (contenu anglais) | Critique et pratique Ressources cliniques Accueil | Manuels * | Revues * | Information médicaments * | Tests de laboratoire * | InfoPOEMs | Guide de pratique clinique | Documents d'information pour les patients * | Bibliothécaire de l'AMC * Raccourcis MD Consult * | STAT!Ref * | [email protected] * | OVID Medline * | Revues EBSCO * | JAMC | Essential Evidence Plus | MedCalc 3000 * FMC / DPC Voir les cours en ligne | Bilan des crédits Gestion de la pratique Accueil | Créez un site Web de pratique | Clinique informatisée | Bureau | Dotation en personnel | Finances | Juridique et vie privée * Service aux membres AMC POEMs veut dire "Patient-Oriented Evidence that Matters". Désirez-vous changer le format de vos courriels d'InfoPOEMs quotidiens ou votre adresse courriel de la liste d'InfoPOEMs quotidiens? Gérez vos options d'InfoPOEMs quotidiens à partir du site Web amc.ca. Cliquez ici pour vous désabonner. Copyright © 1995-2009 InfoPOEM, Inc. www.infopoems.com. Tous droits réservés. Copyright © 2009 Association Médicale Canadienne, Tous droits réservés.
