A Possible Changing Of The Guard For Shoulder Impingement Syndrome: A Systematic Review And Meta-analysis Comparing Nonsteroidal Anti-inflammatory And Corticosteroid Injections

Purpose: To determine optimal treatment strategies for shoulder impingement syndrome by comparing subacromial injections of non-steroidal anti-inflammatories and corticosteroids on pain relief and functional improvement in individuals with shoulder impingement syndrome. Secondly, to perform a cost analysis of the two injections. Methods: MEDLINE, SPORTDiscus, CINAHL, Embase, Web of Science, and SCOPUS databases were searched for randomized controlled trials. Keywords included pain, shoulder, impingement syndrome, non-steroidal anti-inflammatory drug, corticosteroid, and injection. Ten studies comparing changes in pain or function in humans with SIS receiving SNIs or SCIs were included. Quality and risk of bias were assessed using the CONSORT 2010 scale and the Cochrane collaboration tools. Baseline and follow-up scores of the visual analogue, Constant-Murley, and University of California-Los Angeles Shoulder scales were extracted to calculate effect sizes, represented as Cohen’s d. Meta-regression and publication bias analyses were performed. Procedural and medication costs were extracted from Medicare guidelines. Results: Seven high and three good quality studies were included, with a mean score of 21.1. Only one study had a high risk of bias. The meta-analyses produced pooled effect sizes of 0.05 (p = 0.83), 0.12 (p = 0.71), and 0.07 (p = 0.79) for each scale respectively, with confidence intervals crossing zero. Procedural costs were equal between groups, while ketorolac was the least costly medication ($0.40 for 15 mg). There was no significant difference in side effects between the two injections. Conclusions: Subacromial injections of non-steroidal anti-inflammatories are as effective as corticosteroids for short-term pain relief and improving function in patients with subacromial impingement syndrome. Additionally, they are less expensive and cause no major difference in complications, providing a viable, cost-effective alternative for injection therapy in patients with subacromial impingement syndrome.