Exercise Therapy and Ultrasound Guided Injections in Painful Shoulder

Frederiksberg University Hospital

Status: Completed

Conditions: Shoulder Bursitis

Treatments: Other: methylprednisolone

Study type: Interventional

Funder types: Other

Identifiers

NCT01506804

H-4-2010-002

Details and patient eligibility

About

Many patients experience an effect of steroid injection, however the effect is often short lasting and recurrence of symptoms is common. The short term effect of injection has been shown to be much better than exercise therapy; however over time the superior effect of injection compared to exercise does not last. Injection in combination with exercise therapy might be a more sufficient therapy than injection alone. The aim of this study is to investigate a combination of steroid injection and a 10 week exercise program. In addition, the study tests the validity of clinical impingement tests using ultrasound verified impingement as gold standard.

Full description

For many patients unspecific pain and reduced motion in the shoulder is a common complaint. It is believed that the main reason for shoulder pain comes from inflammation of the bursa.

Many patients experience an effect of steroid injection, however the effect is often short lasting and recurrence of symptoms is common. Exercise therapy for the muscles around the shoulder joint is also common treatment for shoulder pain. The short term effect of injection has been shown to be much better than exercise therapy; however over time the superior effect of injection compared to exercise does not last. The anti-inflammatory and pain releasing effect of steroid injection in combination with exercise therapy increasing the strength and control of the muscles around the shoulder joint, might be a more sufficient therapy than injection alone. Thus, the aim of this study is to investigate a combination of steroid injection and a 10 week exercise program in patients with a painful shoulder.

Many different clinical tests are used to examine the pathological compression of the bursa during motion in the shoulder joint (impingement). However, it is actually not known if the pain in motion is caused by compression of the bursa. Part of this study therefore is to test the validity of clinical impingement tests using ultrasound verified impingement as gold standard.

Studies comparing injection given guided by ultrasound to blind injections have shown that the ultrasound guided injections are more likely to place the active stuff correctly in the swollen bursa. In this study all injections will be given ultrasound guided. In the ultrasound examination the thickness of the bursa will be measured in all patients in order to investigate if swollenness of the bursa can explained the pain and dysfunction of the shoulder joint

Enrollment: 99 patients

Sex: All

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Pain and reduced motion in the shoulder for more than four weeks
• Ultrasound verified swollenness of the bursa.

Exclusion criteria

• Bilateral pain in the shoulder joints
• Rupture of the rotator cuff or biceps tendons
• Generalised disease which can explain the shoulder pain
• OA in the shoulder joint
• Diabetes
• Positive compression test of the cervical spine

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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99 participants in 2 patient groups, including a placebo group

Training of painful shoulder

Experimental group

Description:

Steroid injection X 2 and 10 weeks exercise program of painful shoulder

Treatment:

Other: methylprednisolone

Contralateral training

Placebo Comparator group

Description:

Steroid injection X 2 and 10 weeks exercise program of asymptomatic shoulder

Treatment:

Other: methylprednisolone