Kortikosteroid Enjeksiyonunun Subakromiyal Sıkışma Sendromunun Konservatif Tedavisinde Etkinliği

Yıl 2018, Cilt: 18 Sayı: 4, 683 - 689, 27.12.2018

Safa Gürsoy

https://doi.org/10.17098/amj.501834

Öz

Amaç: Çalışmamızın amacı omuz subakromial sıkışma sendromunun (SSS) tedavisinde tek başına fizik

tedavi ile fizik tedavi ile kombine subakromial kortikosteroid enjeksiyonu uygulamasının etkinliğinin

karşılaştırılmasıdır.

Materyal ve Metot: 30‐65 yaş arası, rotator kılıf yırtığı olmayan 56 SSS tanısı alan hasta çalışmaya dahil

edildi. Yalnızca fizik tedavi alan hastaların oluşturduğu Grup 1(n=26) ile fizik tedavi ile birlikte

subakromial kortikosteroid enjeksiyonu yapılan hastaların oluşturduğu Grup 2(n=30), işlem öncesi

döneme kıyasla 3., 6. ve 12. ayda ölçülen Visual Analog Scale (VAS) ve American Shoulder and Elbow

Surgeons (ASES) skorlamaları kullanılarak karşılaştırıldı.

Bulgular: Her iki grup arasında anlamlı farklılık 3. ve 6. ay VAS ve ASES skorlarında Grup 2(fizik tedavi

ile birlikte enjeksiyon uygulaması) lehine bulunmuştur (p<0,001) 12. ay takiplerinde VAS(p=0,539) ve

ASES(p=0,117) ölçümlerindeki değişim, gruplar açısından istatistiksel olarak anlamlı değildir. Her iki

grupta da işlem öncesi döneme göre 3. ve 6. ay takiplerinde istatistik olarak anlamlı bir artış

saptanmıştır.

Sonuç: Kortikosteroid enjeksiyonu ile birlikte fizik tedavi uygulaması sadece fizik tedavi uygulaması ile

kıyaslandığında kısa dönemde daha etkili olduğu ancak her iki yöntemin de ağrıyı azalttığı ve

fonksiyonlarda iyileşme sağladığı düşünülmektedir.

Anahtar Kelimeler

Subakromial sıkışma sendromu, kortikosteroid enjeksiyonu, fizik tedavi

Efficacy of Corticosteroid Injection in the Conservative Treatment of Subacromial Impingement Syndrome

Öz

Objectives: The aim of our study was to compare the efficacy of
physical therapy and the combination of physical therapy and subacromial
corticosteroid injection in the treatment of shoulder subacromial impingement
syndrome (SIS).

Materials and Methods: 56 patients aged between 30-65, who did not have a
rotator cuff tear and were diagnosed with SIS, were enrolled in this study.
Group 1 (n=26) constituted by patients who were only receiving physical therapy
and Group 2 (n=30) constituted by patients who were receiving the combination
of physical therapy and subacromial corticosteroid injection were compared
using Visual Analogue Scale (VAS) and American Shoulder and Elbow Surgeons
(ASES) scores at post-treatments months 3, 6 and 12 in comparison to the
pre-treatment period.

Results: There was a statistically significant difference between the two groups
in favor of Group 2 (combination of physical therapy and injection) in terms of
VAS and ASES scores at months 3 and 6 (p<0.001). The change in VAS (p=0.539)
and ASES (p=0.117) measurements of the groups at month 12 was not statistically
significant. There was a statistically significant increase in both groups
throughout the 3^rd and 6^th months follow-up period as
compared to the pre-treatment period.

Conclusion: It is thought that the combination of corticosteroid
injection and physical therapy is more effective in the short-term as compared
to physical therapy only, however both methods alleviate pain and provide
improvement in functions.  

Anahtar Kelimeler

Subacromial impingement syndrome, corticosteroid injection, physical therapy

Kaynakça

• 1. Chard M, Hazleman R, Hazleman BL, King RH, Reiss BB. Shoulder disorders in the elderly: a community survey. Arthritis Rheum 1991;34:766–9.
• 2. Picavet HS, Schouten JS. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study. Pain 2003;102:167–78.
• 3. van der Windt DA, Koes BW, de Jong BA, Bouter LM. Shoulder disorders in general practice: incidence, patient characteristics and management. Ann Rheum Dis 1995;54:959–64.
• 4. Neer CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am 1972;54(1):41–50.
• 5. Hanchard NC1, Goodchild L, Thompson J, O'Brien T, Davison D, Richardson C. Evidence-based clinical guidelines for the diagnosis, assessment and physiotherapy management of contracted (frozen) shoulder: quick reference summary. Physiotherapy. 2012;98(2):117-20.
• 6. Neer CS. Impingement lesions. Clin Orthop Relat Res 1983;173:70–7.
• 7. Neer CS, Welsh RP. The shoulder in sports. Orthop Clin North Am 1977;8: 583–91.
• 8. Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med 1980;8:151–8.
• 9. Dorrestijn O, Stevens M, Winters JC, van der Meer K, Diercks RL. Conservative or surgical treatment for subacromial impingement syndrome? A systematic review. J Shoulder Elbow Surg 2009;18(4):652–60.
• 10. Gebremariam L, Hay EM, Koes BW, Huisstede BM. Effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome: a systematic review. Arch Phys Med Rehabil 2011;92(11):1900–13.
• 11. Kibler WB, McMullen J, Uhl T. Shoulder rehabilitation strategies, guidelines and practice. Orthop Clin N Am 2001;32:527–38.
• 12. Engebretsen K, Grotle M, Bautz-Holter E, Sandvik J, Juel NG, Ekeberg OM, Brox JL. Radial extracorporeal shockwave treatment compared with supervised exercises in patients with subacromial pain syndrome: single blind randomised study. BMJ 2009;339:b3360.
• 13. Crawshaw DP, Helliwell PS, Hensor EM, Hay EM, Aldous SJ, Conaghan PG. Exercise therapy after corticosteroid injection for moderate to severe shoulder pain: large pragmatic randomised trial. BMJ 2010;340:c3037.
• 14. Holmgren T, Bjornsson Hellgren H, Oberg B, Adolfsson L, Johansson K. Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. BMJ 2012;344:e787.
• 15. Ottenheijm RP, Jansen MJ, Staal JB, van den Bruel A, Weijers RE, de Bie RA. Accuracy of diagnostic ultrasound in patients with suspected subacromial disorders: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2010;91(10):1616–25.
• 16. Chen MJ, Lew HL, Hsu TC, Tsai WC, Lin WC, Tang SF. Ultrasoundguided shoulder injections in the treatment of subacromial bursitis. Am J Phys Med Rehabil. 2006;85(1):31–5.
• 17. Diercks R, Bron C, Dorrestijn O, Meskers C, Naber R, de Ruiter T. Guideline for diagnosis and treatment of subacromial pain syndrome. Acta Orthop. 2014;85(3):314–22.
• 18. Hanratty CE, McVeigh JG, Kerr DP, Basford JR, Finch MB, Pendleton A. The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. Semin Arthritis Rheum. 2012;42(3):297–316.
• 19. Koester MC, Dunn WR, Kuhn JE, Spindler KP. The efficacy of subacromial corticosteroid injection in the treatment of rotator cuff disease: A systematic review. J Am Acad Orthop Surg. 2007;15(1):3–11.
• 20. Toigo M, Boutellier U. New fundamental resistance exercise determinants of molecular and cellular muscle adaptations. Eur J Appl Physiol. 2006;97(6):643–63.
• 21. Cole BF, Peters KS, Hackett L, Murrell GA.Ultrasound-Guided Versus Blind Subacromial Corticosteroid Injections for Subacromial Impingement Syndrome: A Randomized, Double-Blind Clinical Trial. Am J Sports Med. 2016;44(3):702-7.
• 22. Bennell K, Wee E, Coburn S, Green S, Harris A, Staples M. Efficacy of standardised manual therapy and home exercise programme for chronic rotator cuff disease: randomised placebo controlled trial. BMJ 2010;340:c2756.
• 23. Johansson K, Bergström A, Schröder K, Foldevi M. Subacromial corticosteroid injection or acupuncture with home exercises when treating patients with subacromial impingement in primary care--a randomized clinical trial. Fam Pract 2011;28(4):355-65.