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Comparative effectiveness of ultrasonophoresis and iontophoresis in impingement syndrome: a double-blind, randomized, placebo controlled trial.
García, I, Lobo, C, López, E, Serván, JL, Tenías, JM
Clinical rehabilitation. 2016;(4):347-58
Abstract
OBJECTIVE To estimate the effectiveness of ultrasonophoresis and iontophoresis with sodium diclofenac used in addition to an exercise program for patients with impingement syndrome. DESIGN Multicentre, double-blind, placebo randomized controlled trial. SETTING "Mancha Centro" Outpatient primary care clinic (Spain). PARTICIPANTS A total of 175 patients were considered, of whom 88 met criteria and agreed. INTERVENTION The patients were randomly assigned to one of three groups: a) standard treatment (supervised exercises and cryotherapy) along with placebo iontophoresis and placebo ultrasonophoresis; b) standard treatment, iontophoresis, and placebo ultrasonophoresis; and c) standard treatment, ultrasonophoresis, and placebo iontophoresis. All patients received 15 treatment sessions. OUTCOME MEASURES Baseline, 6-, and 12-week evaluations were carried out. Functionality, pain, range of motion, strength and quality of life were assessed with the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), Constant-Murley score, and SF-36 scale. RESULTS Ultrasonophoresis group experienced significant decreases in pain compared to the standard treatment group (12.7 and 13.5 points in "bodily pain" dimension of SF-36; and 1,5 and 2,2 points in "pain" dimension of Constant Murley after 6 and 12 weeks of therapy, respectively). They also reported improved range of motion compared to the exercises group (2,1 points in Constant-Murley after 6 weeks and 12 weeks), better vitality and overall health (SF-36 dimensions). Iontophoresis, however, led to no significant improvements when added to the standard treatment. CONCLUSION In patients with impingement syndrome, a combination of ultrasonophoresis and an exercise program are better than a combination of iontophoresis and the same exercise program or the exercise program alone.
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Evaluation of the effectiveness of three physiotherapeutic treatments for subacromial impingement syndrome: a randomised clinical trial.
Pérez-Merino, L, Casajuana, MC, Bernal, G, Faba, J, Astilleros, AE, González, R, Giralt, M, Romeu, M, Nogués, MR
Physiotherapy. 2016;(1):57-63
Abstract
OBJECTIVE To determine whether dexketoprofen administered by phonophoresis or iontophoresis is more effective for the treatment of subacromial impingement syndrome (SIS) than conventional ultrasound therapy. DESIGN Randomised clinical trial. SETTING University hospital. PARTICIPANTS Ninety-nine participants with SIS without a complete tear of the rotator cuff were assigned at random to three intervention groups. INTERVENTION GROUPS Participants received ultrasound (n=32), phonophoresis with dexketoprofen (50mg/session) (n=33) or iontophoresis with dexketoprofen (50mg/session) (n=34). All participants completed 20 treatment sessions plus exercise therapy and cryotherapy. OUTCOME MEASURES A visual analogue scale (VAS), the Constant-Murley Scale (CMS) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were administered pre-treatment (baseline), post-treatment and 1 month post-treatment. RESULTS At baseline, there were no differences between the groups. Post-treatment, VAS score improved by -1.2 points and CMS score improved by 8.9 points in the ultrasound group compared with the iontophoresis group [95% confidence interval (CI) -0.2 to -2.2 and 95% CI 17.0 to 0.7, respectively]. CMS score improved by 7.1 points in the phonophoresis group compared with the iontophoresis group (95% CI 14.8 to -0.7). At 1 month post-treatment, no significant differences were detected between the groups. VAS, CMS and DASH scores of all groups improved post-treatment and at 1 month post-treatment. CONCLUSION Ultrasound, iontophoresis with dexketoprofen and phonophoresis with dexketoprofen can improve pain, shoulder function, and physical functioning and symptoms in the upper limb in patients with SIS without a complete tear of the rotator cuff. CLINICAL TRIALS. GOV REGISTRATION NUMBER NCT01748188.
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A double-blind randomized controlled trial comparing the effects of subacromial injection with corticosteroid versus NSAID in patients with shoulder impingement syndrome.
Min, KS, St Pierre, P, Ryan, PM, Marchant, BG, Wilson, CJ, Arrington, ED
Journal of shoulder and elbow surgery. 2013;(5):595-601
Abstract
HYPOTHESIS The objective of this study was to compare the efficacy of subacromial injection of triamcinolone compared to injection of ketorolac in the treatment of external shoulder impingement syndrome. METHODS Thirty-two patients diagnosed with external shoulder impingement syndrome were included in this double-blinded randomized controlled clinical trial. Each patient was randomized into the steroid group or nonsteroidal anti-inflammatory drugs (NSAID) group. The steroid syringe contained 40 mg triamcinolone; and the NSAID syringe contained 60 mg ketorolac. Each patient was evaluated in terms of arc of motion, visual analog scale (VAS) for evaluating pain, and the UCLA (The University of California at Los Angeles) shoulder rating scale. RESULTS At 1 month follow-up, both treatment arms resulted in increased range of motion and decreased pain. The steroid group decreased in active abduction while the NSAID group increased (steroid: 134°, NSAID 151°, P = .03). The mean improvement in the UCLA shoulder rating scale at 4 weeks was 7.15 for the NSAID group and 2.13 for the steroid group (P = .03). Subgroup analysis of the UCLA scale demonstrated an increase in both forward flexion strength (P = .04) and patient satisfaction (P = .03) in the NSAID group. No significant difference could be seen in all other outcome measures. CONCLUSION In this study, an injection of ketorolac resulted in greater improvements in the UCLA shoulder rating scale than an injection of triamcinolone at 4 weeks follow-up. While both triamcinolone and ketorolac are effective in the treatment of isolated subacromial impingement, ketorolac appears to have equivalent if not superior efficacy; all the while decreasing patient exposure to the potential side-effects of corticosteroids.
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Is local subacromial corticosteroid injection beneficial in subacromial impingement syndrome?
Akgün, K, Birtane, M, Akarirmak, U
Clinical rheumatology. 2004;(6):496-500
Abstract
Subacromial corticosteroid injection is one of the most frequently used management tools in subacromial impingement syndrome (SIS) despite controversial reports on the efficacy. Our purpose, in this single blinded, randomised and controlled study was to clarify whether the corticosteroid injection provides additional benefit when used with other conservative treatment modalities in 48 patients with stage 2 SIS. The patients were randomly divided into three groups according to the two therapeutic injections applied with a 10-day interval: group 1: 10 cc of 1% lignocaine + 40 mg of methylprednisolone for the first and second injections, group 2: 10 cc of 1% lignocaine + 40 mg of methylprednisolone for the first injection and only 10 cc of 1% lignocaine for the second injection, group 3: only 10 cc of 1% lignocaine for the first and second injections. All the patients were prescribed 500 mg of naproxen sodium to use two times daily, instructed to rest and perform Codman's pendulum exercises during the first 15 days. Shoulder pain during rest, activity, and causing disturbance of sleep was evaluated using a visual analogue scale and shoulder function was investigated by total Constant score and its subsectional parameters which are pain, daily living activities, active range of motion and strength before the therapy and 1 and 3 months after the therapy onset. Significant improvements from the baseline values in all pain and function parameters were observed at the first and second evaluation in all groups. Group 1 patients had more favourably improved values in pain causing sleep disturbance and daily living activity parameters than group 2 and 3 patients only in the 1st month after therapy onset. We found that subacromial corticosteroid injections in the acute or subacute phase of SIS provided additional short-term benefit without any complication when used together with nonsteroidal anti-inflammatory drugs (NSAIDs) and exercise.