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Subacromial Impingement Syndrome: Effectiveness of Pharmaceutical Interventions–Nonsteroidal Anti-Inflammatory Drugs, Corticosteroid, or Other Injections: A Systematic Review

Published:December 13, 2012DOI:https://doi.org/10.1016/j.apmr.2012.11.041

      Abstract

      Objective

      To present an evidence-based overview of the effectiveness of pharmaceutical interventions, including nonsteroidal anti-inflammatory drugs, corticosteroid injections, and other injections, used to treat the subacromial impingement syndrome (SIS). An overview can help physicians select the most appropriate pharmaceutical intervention, and it can identify gaps in scientific knowledge.

      Data Sources

      The Cochrane Library, PubMed, Embase, PEDro, and CINAHL databases.

      Study Selection

      Two reviewers independently selected relevant reviews and randomized clinical trials.

      Data Extraction

      Two reviewers independently extracted the data and assessed the methodologic quality.

      Data Synthesis

      A best evidence synthesis was used to summarize the results. Three reviews and 5 randomized clinical trials were included. Although we found limited evidence for effectiveness in favor of 2 sessions with corticosteroid injections versus 1 session, for the effectiveness of corticosteroid injections versus placebo, nonsteroidal anti-inflammatory drugs, or acupuncture, only conflicting and no evidence for effectiveness was found. Moderate evidence was found in favor of immediate release oral ibuprofen compared with sustained-released ibuprofen in the short-term. Also, moderate evidence for effectiveness was found in favor of glyceryltrinitrate patches versus placebo patches in the short-term and mid term. Furthermore, injections with disodium ethylene diamine tetraacetic acid plus ultrasound with ethylene diamine tetraacetic acid gel were more effective (moderate evidence) than was placebo treatment in the short- and long-term.

      Conclusions

      This article presents an overview of the effectiveness of pharmaceutical interventions for SIS. Some treatments seem to be promising (moderate evidence) to treat SIS, but more research is needed before firm conclusions can be drawn.

      Keywords

      List of abbreviations:

      CANS (Complaints of the Arm, Neck, and/or Shoulder), CI (confidence interval), EDTA (ethylene diamine tetraacetic acid), GTN (glyceryltrinitrate), NSAIDs (nonsteroidal anti-inflammatory drugs), RCT (randomized clinical trial), ROM (range of motion), SIS (subacromial impingement syndrome)
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