(Research Hub Theater) Comparative Effectiveness of Particulate versus Non-particulate Corticosteroid Injections for the Treatment of Musculoskeletal Pathologies of the Glenohumeral Joint
Resident Stanford University PM&R Program Mountain View, California
Objective: This study aims to determine if particulate or non-particulate corticosteroid injections are more effective at treating pain from musculoskeletal pathologies of the glenohumeral joint.
Design: A single center, single blind, prospective, randomized trial.
Setting: A single academic center’s outpatient sports medicine clinics
Participants: 74 subjects who were scheduled to receive a glenohumeral corticosteroid injection as a part of their routine care
Interventions: All subjects received an ultrasound-guided glenohumeral joint injection with either particulate steroid (40mg triamcinolone or 6mg of betamethasone) or non-particulate steroid (10mg of dexamethasone). Treating physicians could order repeat corticosteroid injections, oral medications, or refer the subject to surgery at their discretion as part of their treatment plan
Main Outcome Measures: Primary outcomes included the categorical proportion of patients that obtained at least 50% pain reduction and number of injections received at 2 weeks and 3 and 6 months follow-up.
Results: Both particulate and non-particulate resulted in statistically significant improvement in pain and function at 2 weeks, 3 months, and 6 months, without clear differences between groups. The particulate group showed a statistically significant improvement in VAS pain score (-2.7, SD 1.9) compared to the non-particulate group (-1.5, SD 2) at 2 weeks only (p = 0.02). There was a statistically significant improvement in QDASH score at 3 months in the non-particulate group (-17.1, SD 16.6) compared to the particulate group (-8.2, SD 12.5) which was not seen at any other time point (p = 0.045). There was no statistical difference in the number of repeat injections between the two groups.
Conclusions: Corticosteroid injections are an effective treatment for musculoskeletal pathologies of the glenohumeral joint. Particulate and non-particulate steroids have similar effectiveness. There may be slight improvement in pain scores at 2 weeks in particulate compared to non-particulate steroids.