Efficacy of subacromial corticosteroid injection for impingement syndrome
Emma Torrance, Michael Walton, Puneet Monga, Adam Watts and Lennard Funk.
Manchester Arm Clinic
Presented at ESSKA, 2015
Background: Subacromial impingement syndrome is common, yet controversies still surround current therapeutic management. A key issue is the efficacy of corticosteroid injections, which often provide only temporary pain relief. We aim to assess the outcome of patients administered subacromial steroid injections and the subsequent conversion to surgery.
Methods: Patients presenting with clinical signs of impingement were retrospectively reviewed over a 12 month period. The cohort consisted of 250 patients (146 male, 104 female) with a mean age of 51.84±11.91. The diagnosis was made clinically, with ultrasound and/or MRI support. Rotator cuff, biceps and acromioclavicular joint pathologies were excluded. All patients had previously undergone physiotherapy treatment and NSAID treatment. Following injection, all patients underwent a targeted scapula, postural and rotator cuff rehabilitation programme. Data regarding patient demographics, treatment, pain relief and final outcome were analysed.
Results: Of 250 impingement patients, 74.1% received a subacromial steroid injection (n=185). 4.8% felt no relief of symptoms (n=8), 39.4% noted temporary relief (n=65) and 55.8% experienced complete relief (n=92) at six week review. Following steroid injection, 22.7% of patients with ongoing symptoms subsequently underwent an arthroscopic subacromial decompression (n=42). Post-operatively, 84.6% of patients noted complete relief and the remaining patients with partial relief at three months post-operatively.
Conclusion: Subacromial corticosteroid injections remain a useful non-surgical method in treating clinical signs of impingement, combined with specific rehabilitation, with only a small number of patients progressing to surgery.
Comments (L Funk):
We undertook this audit/study to properly assess how many patients improved with a steroid injection and targeted rehabilitation. Plus, of those that failed, how many elected to have surgery.
It was extremely useful and interesting to see that the vast majority of patients improved with steroid injection and rehab (95.2%!!). Of the patients that did not experience complete pain relief only 22.7% felt sufficient pain to undergo surgery.
This is extremely useful information for us when discussing the treatment options with patients and aiding their decision-making.