| Methods |
Randomised controlled trial
Blinding: both participants and outcome assessors were blinded
Loss to follow‐up: none reported
Appropriate statistical analysis: yes, intention to treat. |
| Participants |
77 patients
Inclusion criteria: diagnosis of pain of soft tissue origin, shoulder or upper arm pain of any duration and of spontaneous or traumatic origin, positive signs on selective tissue tension examination of shoulder structures classified on basis of clinical criteria as:
1. Supraspinatus tendonitis
2. Infraspinatus tendonitis
3. Subscapularis tendonitis
4. Bursitis
5. A.C. joint sprain
6. Capsulitis.
Exclusion criteria: patients with predominantly neck pain, paraesthesiae or neurological signs in arms or hands, specific arthritis (septic, gout, pseudogout), polyarthritis and generalised disease relevent to the symptoms, radiological evidence of osteoarthritis or other bone disease, overt or predominant psychological overlay |
| Interventions |
Group 1(38 patients): Tender or trigger point injection of 2ml, 40 mg methylprednisolone acetate mixed with 1% lignocaine. The most tender point which reproduced the patients pain was identified by deep palpation.
Group 2 (39 patients): "Functional" injection, the site of the injection being the anatomical area (ie rotator cuff tendon, subacromial bursa) indicated by the selective tissue tension examination. The same injection solution was used.
At one week, if the pain had not cleared completely or considerably diminished, the alternative (cross over) injection was given. If the crossover injection was not effective after one week then the original injection was given again (recrossover). |
| Outcomes |
Assessed at baseline, 1, 4 weeks. Success defined as reduction in pain from severe to mild or nil, with corresponding clearing of signs on objective examination. |
| Notes |
Patients randomly assigned to treatment group by physician giving the injections.
Crossover and recrossovers after one and two weeks as per protocol. Only 1 week data included in review ‐ see analyses 3. Ten of the "successes" at 1 week had a different pattern of pain at one week. All patients who were considered "success" at 1 week maintained their relief at 4 and 8 weeks apart for the 5 patients who presented with new injuries or spontaneous recurrences. |
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Allocation concealment? |
High risk |
C ‐ Inadequate |
