Effects of Subacromial Bursa Injection With Corticosteroid and Hyaluronidase According to Dosage
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Objective To evaluate effects of subacromial bursa injection with steroid according to dosage and to investigate whether hyaluronidase can reduce steroid dosage. Methods Thirty patients with periarticular shoulder disorder were assigned to receive subacromial bursa injection once a week for two consecutive weeks. Ten patients (group A) underwent subacromial bursa injection with triamcinolone 20 mg; another group of ten patients (group B) with hyaluronidase 1,500 IU and triamcinolone 20 mg; and the other ten patients (group C) with triamcinolone 40 mg. We examined the active range of motion (AROM) of the shoulder joint, visual analogue scale (VAS), and shoulder disability questionnaire (SDQ) at study entry and every week until 1 week after the 2nd injection. Results All groups showed statistically significant improvements in VAS after 1st and 2nd injections. When comparing the degree of improvement in VAS, there were statistically significant differences between groups C and A or B, but not between groups A and B. SDQ was statistically significantly improved only in groups B and C, as compared to pre-injection. There were statistically significant differences in improvement of SDQ after the 2nd injection between groups C and A or B. Statistically significant improvements in AROM were shown in abduction (groups B and C) and in flexion (group C only). Conclusion Repeated high-dose (40 mg) steroid injection was more effective in terms of pain relief and functional improvements of shoulder joint than medium-dose (20 mg) steroid injection in periarticular disorder. Hyaluronidase seems to have little additive effect on subacromial bursa injection for reducing the dosage of steroid.
Abstract
Objective To evaluate effects of subacromial bursa injection with steroid according to dosage and to investigate whether hyaluronidase can reduce steroid dosage. Methods Thirty patients with periarticular shoulder disorder were assigned to receive subacromial bursa injection once a week for two consecutive weeks. Ten patients (group A) underwent subacromial bursa injection with triamcinolone 20 mg; another group of ten patients (group B) with hyaluronidase 1,500 IU and triamcinolone 20 mg; and the other ten patients (group C) with triamcinolone 40 mg. We examined the active range of motion (AROM) of the shoulder joint, visual analogue scale (VAS), and shoulder disability questionnaire (SDQ) at study entry and every week until 1 week after the 2nd injection. Results All groups showed statistically significant improvements in VAS after 1st and 2nd injections. When comparing the degree of improvement in VAS, there were statistically significant differences between groups C and A or B, but not between groups A and B. SDQ was statistically significantly improved only in groups B and C, as compared to pre-injection. There were statistically significant differences in improvement of SDQ after the 2nd injection between groups C and A or B. Statistically significant improvements in AROM were shown in abduction (groups B and C) and in flexion (group C only). Conclusion Repeated high-dose (40 mg) steroid injection was more effective in terms of pain relief and functional improvements of shoulder joint than medium-dose (20 mg) steroid injection in periarticular disorder. Hyaluronidase seems to have little additive effect on subacromial bursa injection for reducing the dosage of steroid.
참고문헌 (17)
- 윤승현, "초음파를 이용한 견봉하 점액낭 내 스테로이드 주사 효과: 두 가지 용량의 비교", Annals of Rehabilitation Medicine, 33(4), pp.402~407 (2009), 대한재활의학회
- Naredo E., "A randomized comparative study of short term response to blind injection versus sonographic guided injection of local corticosteroids in patients with painful shoulder", J Rheumatol, 31, pp.308~314 (2004)
- Chen MJ., "Ultrasound-guided shoulder injections in the treatment of subacromial bursitis", Am J Phys Med Rehabil, 85, pp.31~35 (2006)
- Blair B., "Efficacy of injections of corticosteroids for subacromial impingement syndrome", J Bone Joint Surg Am, 78, pp.1685~1689 (1996)
- Seo JH., "The effect of intraarticular injection of hyaluronidase in patients with adhesive capsulitis of shoulder", Clin Pain, 5, pp.122~127 (2006)
- Seung Deuk Byun, "Subacromial Bursa Injection of Hyaluronate with Steroid in Patients with Peri-articular Shoulder Disorders", Annals of Rehabilitation Medicine, 35(5), pp.664~672 (2011), 대한재활의학회
- Chou WY., "Effect of sodium hyaluronate treatment on rotator cuff lesions without complete tears : a randomized, double-blind, placebo-controlled study", J Shoulder Elbow Surg, 19, pp.557~563 (2010)
- 조강희, "견봉하 삼각근하 점액낭 주사 시 맹검 접근법과 초음파 하 접근법의 비교", Annals of Rehabilitation Medicine, 34(2), pp.209~213 (2010), 대한재활의학회
- Tillander B., "Effect of steroid injections on the rotator cuff : an experimental study in rats", J Shoulder Elbow Surg, 8, pp.271~274 (1999)
- Akpinar S., "Effects of methylprednisolone and betamethasone injections on the rotator cuff : an experimental study in rats", Adv Ther, 19, pp.194~201 (2002)
- Byun SD., "Effect of three consecutive steroid injection on blood glucose and cortisol level in diabetic patients with hemiplegic shoulder pain", Clin Pain, 9, pp.82~89 (2010)
- van Den Ende CH., "Assessment of shoulder function in rheumatoid arthritis", J Rheumatol, 23, pp.2043~2048 (1996)
- 김철, "유착성 견관절염 환자에서 하이알루론산과 스테로이드 병용요법의 효과", Annals of Rehabilitation Medicine, 34(3), pp.310~315 (2010), 대한재활의학회
- Menzel EJ., "Hyaluronidase and its substrate hyaluronan : biochemistry, biological activities and therapeutic uses", Cancer Lett, 131, pp.3~11 (1998)
- Remy M., "Efficacy and safety of hyaluronidase 75 IU as an adjuvant to mepivacaine for retrobulbar anesthesia in cataract surgery", J Cataract Refract Surg, 34, pp.1966~1969 (2008)
- Doumouchtsis SK., "Prospective evaluation of combined local bupivacaine and steroid injections for the management of chronic vaginal and perineal pain", Arch Gynecol Obstet, 284, pp.681~685 (2011)
- Lee KJ., "Nerve root block with corticosteroids, hyaluronidase and local anesthetic in the failed back surgery syndrome", Clin Pain, 12, pp.191~194 (1999)