Subacromial Methylprednisolone Versus Ketorolac for Shoulder Impingement

Subacromial Injection of Methylprednisolone Versus Ketorolac to Treat Shoulder Impingement: a Double-blind Randomized Controlled Trial

The investigators aim to compare subacromial ketorolac (non-steroidal anti-inflammatory drug) versus methylprednisolone (steroid) for the treatment of shoulder impingement syndrome.

Because of the current conflicting evidence, the lack of long-term follow-up, and the multiple potential benefit benefits to the society, the investigators aim to compare subacromial ketorolac versus methylprednisolone for the treatment of shoulder impingement syndrome. The investigators hypothesize that patients with shoulder impingement treated with a subacromial methylprednisolone versus ketorolac have similar outcomes based on the ASES (American Shoulder and Elbow Surgeon) self-assessment score. The study will be performed at one institution, the University of Texas Medical Branch.

Inclusion Criteria:

• Age >18 years
• Severe or recalcitrant shoulder impingement syndrome
• Subacromial injection is a therapeutic option

Exclusion Criteria:

• Allergy or intolerance to steroids within less than 1 month
• Allergy or intolerance to NSAIDs within less than 1 month
• Pregnancy
• Breastfeeding
• Pre-existing asthma
• Uncontrolled psychiatric illness
• Previous shoulder injection within the past 3 months
• Evidence of confounding shoulder pathology on imaging
• History of a full-thickness rotator cuff tear
• Ipsilateral cervical radiculopathy
• Moderate to severe glenohumeral arthritis
• Systemic inflammatory conditions
• Kidney disease
• Liver disease
• Gastrointestinal ulcer
• Bleeding disorder
• Pending litigation or work-related claims related to the shoulder
• Previous shoulder surgery on the affected shoulder
• Evidence of local infection
• Evidence of adhesive capsulitis
• Evidence of shoulder instability