| Methods |
Randomised, controlled trial. Blinding: both participants and
outcome assessors were blinded.
Loss to follow‐up: Can't tell
Appropriate statisticial analysis: unclear |
| Participants |
40 patients.
Inclusion criteria:
1. at least 3 months of symptoms
2. diagnosis of subacromial impingement syndrome on the basis of the lidocaine injection test
3. no previous subacromial corticosteroid injections
4. no evidence of os acromiale on plain X‐Ray
5. not involved in workers' compensation claim related to the shoulder
6. no clinical or radiographic evidence of full thickness rotator cuff tear |
| Interventions |
Group 1(21 patients): 6ml of 1% lidocaine without epinephrine.
Group 2 (19 patients): 2ml containing 40 mg of triamcinolone acetonide per ml with 4 ml of 1% lidocaine without epinephrine.
All patients underwent a standardized program of physiotherapy. |
| Outcomes |
Assessed at baseline and every 4 weeks until completion of study (not defined) ‐ (mean duration of follow up was 33 weeks (range: 12‐55) and 28 weeks (range: 12‐52) in corticosteroid and placebo groups respectively).
1. Performance of 5 activities of daily living (ability to use back pocket, wash opposite axilla, eat with utensils, wash or comb hair, perform toilet functions). Assessed by outcome assessor. Three‐point scale for each item (0=unable to do, 1 ‐with difficulty, 2‐ without difficulty). Mean overall score out of 10
2. Overall subjective assessment of pain on 4 point scale (0=no, 1=mild, 2=moderate, 3=severe pain) and whether pain was decreased, unchanged or worse compared to before the injection.
3. Detailed physical examination documenting muscle atrophy, areas of localised tenderness, ROM using a goniometer (forward flexion, external rotation and internal rotation), presence of impingement (as described by Neer). |
| Notes |
Met inclusion criteria for review, however the exact timing of comparisons between groups is not provided ('most recent follow‐up'), and no measure of variance reported and no means of calculating it. Therefore not included in the meta‐analysis.
Results:
At the most recent follow‐up evaluation, at a mean of 33 weeks in corticosteroid group and 28 weeks in placebo group, the corticosteroid group was significantly better with respect to pain and range of motion but there was no significant difference between the two groups with respect to improvement in performance of activities of daily living. |
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Allocation concealment? |
Unclear risk |
B ‐ Unclear |
