Steroid Injections and PEMF
We cannot recommend for or against subacromial corticosteroid injection or Pulsed Electromagnetic Field (PEMF) in the treatment of rotator cuff-related symptoms in the absence of a full thickness tear.
Rationale
We found one Level I study63that evaluated the effect of subacromial corticosteroid injections on patients who had previously had 6 weeks of unsuccessful physical therapy and 2 weeks of NSAIDS for rotator cuff-related symptoms in the absence of a full-thickness tear. The authors reported no differences at 3 and 6 months in ASES scores, DASH scores or pain with impingement testing between groups. However, five Level II studies61, 64, 65, 66, 67 report conflicting results for the effect of subacromial steroid injections for durations between 2 and 6 weeks. These studies report various results for outcomes of pain and function and also vary in that some studies report results for one steroid injection while others report results for multiple steroid injections. The work group’s overall assessment of this evidence was conflicting. Because of these conflicting results, this recommendation is supported by inconclusive evidence.
Two Level II studies68, 69 also examined the use of pulsed electromagnetic field (PEMF) in patients diagnosed with rotator cuff related symptoms. One study69reported no statistically significant differences in pain or Constant-Murley scores in patients treated with PEMF as compared to those treated with sham-controls. In the second study68 the authors measured pain on the VAS scale and found a statistically significant difference in favor of PEMF. Based on these conflicting results, the work group does not have sufficient evidence to provide specific treatment recommendations in regard to PEMF.
Two Level II studies68, 69 also examined the use of pulsed electromagnetic field (PEMF) in patients diagnosed with rotator cuff related symptoms. One study69reported no statistically significant differences in pain or Constant-Murley scores in patients treated with PEMF as compared to those treated with sham-controls. In the second study68 the authors measured pain on the VAS scale and found a statistically significant difference in favor of PEMF. Based on these conflicting results, the work group does not have sufficient evidence to provide specific treatment recommendations in regard to PEMF.
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- (69) Aktas I, Akgun K, Cakmak B. Therapeutic effect of pulsed electromagnetic field in conservative treatment of subacromial impingement syndrome. Clin Rheumatol 2007;26(8):1234-1239.