Randomised controlled trial of single, subacromial injection of methylprednisolone in patients with persistent, post-traumatic impingment of the shoulder

Objective: To evaluate the impact on recovery, of single subacromial injection of methylprednisolone in patients with persistent, post-traumatic impingement of the shoulder. Design: Randomised, controlled study. Setting: Large accident and emergency department in Leicester, UK. Participants: 98 patients with persistent, post-traumatic impingement of the shoulder. Intervention: Single subacromial injection of methylprednisolone with bupivicaine ( group S, n=54) or bupivicaine only ( group C, n=44). Main outcome measures: Pain using a 10 cm visual analogue scale ( VAS) and active shoulder abduction. Results: Comparison of pain scores by the 10 cm VAS between group and group C showed no statistical difference at 3, 6, or 12 weeks. Mean patient pain scores at 12 weeks were 1.38 in both groups (p=0.99). There were 16 patients in group S ( mean age 52 years) with a 10 cm VAS greater than 1 (95% CI CI 0.17 to 0.43), compared with 13 patients ( mean age 57 years) in group C ( 95% CI 0.17 to 0.45). Comparison of active shoulder abduction between group S and group C showed no statistical difference at 3, 6, or 12 weeks. Mean active abduction at 12 weeks was 168.9degrees in group S and 170.3degrees in group C ( p= 0.8). There were 10 patients in group S ( mean age 60.5) with active abduction less than 170 at 12 weeks ( 95% CI 0.09 to 0.31), compared with five patients ( mean age 62 years) in group C ( 95% CI 0.04 to 0.24). Conclusions: Single subacromial injection of methylprednisolone has no beneficial impact on reducing the pain, or the duration of immobility in patients with persistent post-traumatic impingement of the shoulder.