Retrospective Evaluation of Patient Outcomes with Ketorolac Shoulder Injections
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BACKGROUND: Corticosteroid injections are a commonly used treatment modality in patients with various shoulder pathologies who have failed to respond to other conservative management options such as systemic NSAID medications and physical therapy. However, clinical trials have demonstrated that corticosteroids demonstrate limitations such as spontaneous tendon rupture following local injection, tendon and ligament atrophy, fragmentation of collagen bundles, decreased mechanical properties, and delayed healing. One could extrapolate that injection of an NSAID medication, such as Ketorolac, may provide similar pain reduction with fewer injurious secondary effects. The objective of this study is to retrospectively examine outcomes in patients after glenohumeral or subacromial injections of Ketorolac. METHODS: This longitudinal, case-series based, retrospective study examines the outcomes in patients who received glenohumeral or subacromial injections of Ketorolac from 1/1/2014 through 3/30/2015 at an outpatient orthopaedic surgery clinic. Shoulder pathologies considered include adhesive capsulitis, atraumatic rotator cuff tears, arthritis, and tendinitis. Dependent variables that were monitored and analyzed include pre and post-injection shoulder specific pain (Visual Analogue Scale) and frequency and severity of adverse events. Other factors considered include co-morbidities, duration of physical therapy pre and post-injection, and other injections received. Established values regarding minimally clinical important differences and mean changes in these variables were compared to published standards. RESULTS: At first follow up, patients in both treatment arms reported decreased pain and increased tolerance of physical therapy following the injection of Ketorolac. In patients receiving glenohumeral injections, 71.4% described a reduction in pain compared to the visit at which they received the Ketorolac injection. On average, these patients reported their pain to be 4.29/10 (VAS) immediately prior to injection and 3.83 at their follow up appointment. For those receiving subacromial space injections, 83.3% noted reduced pain, with pain decreasing on average from 6.77 to 2.17. Importantly, no serious side effects were reported, despite many patients presenting with significant comorbidities. CONCLUSIONS: A Ketorolac injection into the glenohumeral joint yielded safe and efficacious results, similar to those seen with injection into the subacromial space. When compared to studies involving the use of corticosteroids for these same shoulder pathologies, Ketorolac appears to have at least equivalent efficacy, without exposing patients to the harmful side effects of corticosteroids.