# Management with ketorolac or corticosteroids for subacromial impingement syndrome: Results from a randomised controlled trial

## TL;DR

A study found that ketorolac injections are as effective as corticosteroids for short-term shoulder pain relief in subacromial impingement syndrome.

## Contribution

This trial provides evidence that ketorolac is non-inferior to corticosteroids for short-term shoulder function improvement in SAIS patients.

## Key findings

- Ketorolac injection showed non-inferiority to corticosteroids in shoulder forward flexion at 3 months.
- Both treatments improved shoulder range of motion, strength, and patient-reported outcomes significantly.
- No injection-related adverse events were reported in either group.

## Abstract

Subacromial impingement syndrome (SAIS) causes shoulder pain and limitations. While corticosteroid injections are common, concerns about side effects lead to exploring alternatives like ketorolac. This trial compared the short‐term effectiveness of subacromial ketorolac versus corticosteroids in SAIS patients.

This double‐blind, randomised controlled trial enrolled 120 patients with clinically diagnosed SAIS. Participants were randomly assigned to receive a single ultrasound‐guided subacromial injection of either ketorolac (30 mg) or methylprednisolone acetate (40 mg). The primary outcome was change in active shoulder forward flexion at 3 months. Secondary outcomes included other shoulder range‐of‐motion measures, shoulder abduction strength, the simple shoulder test (SST) and the Oxford shoulder score (OSS). Between‐group comparisons were performed using baseline‐adjusted analyses of covariance, with a noninferiority margin of −10° prespecified for the primary outcome.

A total of 118 patients completed the 3‐month follow‐up and were included in the final analysis (two dropouts). Both groups demonstrated statistically significant improvements from baseline in shoulder range of motion, strength and patient‐reported outcomes (p < 0.001). The adjusted mean difference in forward flexion between the ketorolac and corticosteroid groups was 0.07° (95% CI, −4.40° to 4.26°), meeting the prespecified criterion for noninferiority. No clinically meaningful between‐group differences were observed for secondary outcomes. No injection‐related adverse events were reported during follow‐up.

Subacromial ketorolac injection produced short‐term improvements comparable to those of corticosteroid injection in patients with SAIS. Ketorolac was non‐inferior to corticosteroids for shoulder forward flexion at 3 months. Longer‐term studies are needed to confirm these findings.

Level I.