Effectiveness of Corticosteroid vs. Ketorolac Shoulder Injections: A Prospective Double-Blinded Randomized Trial

Michael Khazzam

Status and phase: Terminated; Phase 4

Conditions: Rotator Cuff Tendinitis; Full Thickness Rotator Cuff Tear

Treatments: Drug: Marcaine (placebo); Drug: Ketorolac; Drug: Kenalog

Study type: Interventional

Funder types: Other

Identifiers

NCT04115644

STU 092014-097

Details and patient eligibility

About

The purpose of this study is to compare the functional outcomes of patients with shoulder pathology treated with either ketorolac or corticosteroid injections, in a randomized double-blinded study. Investigators will compare the effectiveness of ketorolac compared to corticosteroid.

Specific Aim 1:

Hypothesis 1: Injection of the shoulder (in the subacromial space) with Ketorolac will be more effective than corticosteroid injection for the treatment of a variety of shoulder pathologies.

The risks associated with this study primarily concern adverse reactions to the study drugs. The drugs used in this study are not narcotics or habit-forming but can have side effects. The patient's physician will screen for any heart, intestinal, or kidney disease or condition that would increase the chance for the patient to have an unwanted side effect.

Full description

The proposed study is a three arm, double-blinded, prospective randomized controlled clinical trial with follow-up immediately after the injection and at day 2, and weeks 1, 2, 4, 6, and 12. In this study investigators will compare the effectiveness of ketorolac compared to corticosteroid.

Subjects being seen for a rotator cuff injury will be randomized into one of three treatment groups pertaining to their pathology. The intervention will begin once the subject has consented and answered the Baseline Outcome Shoulder Questionnaire. The Baseline Outcome Questionnaire consists of the Visual Analog Score, American Shoulder and Elbow Score, Single Assessment Numeric Evaluation, Pittsburgh Sleep Quality Index, Short Form-12, and questions pertaining to patient characteristics, injury characteristics, co-morbidities, patient history, medications, and demographics.

Enrollment: 82 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Rotator Cuff Tendinitis
• Atraumatic Rotator Cuff Tear
• Rotator Cuff Tear Arthropathy
• Subjects who speak English

Exclusion criteria

• Age: < 18 years old
• Prior Shoulder Surgery
• Fracture
• Acute Traumatic Rotator Cuff Tear
• Infection
• Uncontrolled Diabetes Mellitus (HbA1c >8)
• Recent Prior Shoulder Injection in either the Subacromial space
• Workers Compensation
• History of Gastric Ulcers
• Tumor Involving the Shoulder Region
• Prior history of gastrointestinal bleeding, allergic reactions, impaired renal function, seizures or cardiac arrhythmias
• Subject unable to provide informed consent
• Subjects who don't speak English
• Patients who are pregnant or lactating at time of screening or are of child bearing age
• Patients currently receiving an aspirin, NSAID regimen or any other anti-inflammatory agents that could affect inflammation response.
• Patients with any bleeding disorders.
• Patients with severe renal failure.
• Patients likely to have severe problems maintaining follow-up, including patients diagnosed with severe psychiatric conditions, patients who live too far outside the hospital's catchment area, patients who are incarcerated and patients who have unstable housing situations.
• Patients who are allergic to aspirin, ketorolac tromethamine and other NSAIDs

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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82 participants in 3 patient groups, including a placebo group

Group 1 (control)

Placebo Comparator group

Description:

will receive an injection of 5 cc 0.25% Marcaine without epinephrine

Treatment:

Drug: Marcaine (placebo)

Group 2 (ketorolac)

Experimental group

Description:

will receive an injection of 3 cc 0.25% Marcaine without epinephrine and 2 cc ketorolac 30 mg/ml

Treatment:

Drug: Ketorolac

Drug: Marcaine (placebo)

Group 3 (kenalog)

Other group

Description:

Pt will receive an injection of 4 cc 0.25% Marcaine without epinephrine and 1 cc triamcinolone. Group 3 is standard of care

Treatment:

Drug: Kenalog

Drug: Marcaine (placebo)