Do steroid injections help physio for massive cuff tears - An RCT
Research type
Research Study
Full title
RCT to determine whether injection prior to Physiotherapy improves the outcome for large - Massive Rotator Cuff Tears: Which muscles are used to replace the Rotator Cuff in patiens with good function and known large - Massive Cuff Tear, and does the location of the tear affect outcomes?
IRAS ID
59379
Contact name
Alison Armstrong
Contact email
Sponsor organisation
Carolyn Maloney
Eudract number
2013-000514-37
Research summary
Research Summary
Research Questions
1. Does injection 1 week prior to physiotherapy improve outcomes in patients with massive rotator cuff tears (RCTs)?
2. Does the tear location and size affect the result of the rehabilitation?
3. Which muscles are utilized to achieve the function and replace the rotator cuff?Pain Relief and Physiotherapy
Ainsworth (2006) demonstrated good outcomes for pain relief and function in patients with massive RCTs, using an exercise program to strengthen the anterior deltoid muscle with 60% success rate. We hypothesise that pain may limit compliance with the physiotherapy regime,we plan to test this with a double blind randomized trial of a steroid and local anaesthetic injection vs local anaesthetic one week before physiotherapy starts to test this. Outcome measures will be VAS scores, constant and Oxford scores initially at 3 and 6 months or end of treatment and one year.Tear location
Machizuki et al (2008) found the anterior 1.5mm of the supraspinatus tendon is the strongest part and carries most of the load. Disruption at this area is thought to give the highest loss of function and power. Various researchers have hypothesised that the site of the tear is possibly an indicator as to whether the patient will retain function after a rotator cuff tear. We wish to study this by relating the site and size of the tear on ultrasound to their recovery.Muscle Activation patterns
Ainsworth (2006) postulated that in patients that do well at physiotherapy, the anterior deltoid is recruited allowing elevation without upward migration of the humeral head, where as other researchers have differing hypotheses. We wish to study which muscles are recruited before and after physiotherapy in patients who do well and those who do not by EMG studies to help improve our understanding and make suggestions for improved physiotherapy regimes.Summary of Results
In patients over 65 years old who have had an injury to damage tendons in their shoulder, we usually treat them with a course of physiotherapy. Some recover well but around half of these people can struggle to improve. We wanted to see if giving these patients an injection helped these patients recover, and also to look at their muscle activation patterns. This was done by recording muscle activation during tasks before and after their course of physiotherapy.
We recruited 20 patients, and gave half of these a long lasting anti-inflamatory injection combined with a short acting pain reliever, and half just a short acting pain reliever injection.
In our study, all of these patients recovered well in function and pain, and there was no significant difference between the results.
The muscle activation patterns did show a difference in patterns of those with a tear of subscapularis (one of the tendons) compared to those without. The main changes in muscle activation were seen in the muscles around the shoulder blade, with patients muscle activity patterns moving to be more like a healthy subject after their treatment.
Our results are useful to show that patients who complete physiotherapy can do very well, and indicates there may be a need for future research to look if patients could get better sooner with more focused exercises, and to see if patients who have had tears for a long time respond similarlyREC name
East Midlands - Derby Research Ethics Committee
REC reference
14/EM/1132
Date of REC Opinion
1 Oct 2014
REC opinion
Further Information Favourable Opinion