• Ole M Ekeberg, Erik Bautz-Holter, Einar K Tveitå, Niels G Juel, Synnøve Kvalheim, and Jens I Brox.
• Department of Physical Medicine and Rehabilitation, Ullevål University Hospital and Medical Faculty, University of Oslo, 0407 Oslo, Norway. o.m.ekeberg@medisin.uio.no
• BMJ. 2009 Jan 1;338:a3112.

ObjectiveTo compare the effectiveness of ultrasound guided corticosteroid injection in the subacromial bursa with systemic corticosteroid injection in patients with rotator cuff disease.DesignDouble blind randomised clinical trial.SettingOutpatient clinic of a physical medicine and rehabilitation department in Oslo, Norway. Patients 106 patients with rotator cuff disease lasting at least three months.InterventionsUltrasound guided corticosteroid and lidocaine injection in the subacromial bursa and lidocaine injection in the gluteal region (local group); corticosteroid and lidocaine injection in the gluteal region and ultrasound guided lidocaine injection in the subacromial bursa (systemic group).Main Outcome MeasuresDifference in improvement in the overall shoulder pain and disability index score after six weeks.ResultsSix weeks after the intervention, the mean difference in improvement in overall shoulder pain and disability index score between the local group and the systemic group was -5.2 (95% confidence interval -13.9 to 3.5); it was -4.1 (-12.3 to 4.1, P=0.32) after adjustment for baseline score. A small but statistically significant difference in improvement between groups occurred in favour of the local group for two secondary outcome measures: the Western Ontario rotator cuff index (8.1, 0.7 to 15.6) and change in main complaint (2.0, 0 to 4).ConclusionsNo important differences in short term outcomes were found between local ultrasound guided corticosteroid injection and systemic corticosteroid injection in rotator cuff disease.Trial RegistrationClinical trials NCT00640575.

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