Shoulder Corticosteroid Injection in Diabetic Patients
Shoulder Corticosteroid Injection in Diabetic Patients
In type 2 diabetic patients affected by chronic shoulder pain, subacromial injection with
 corticosteroid could be an effective treatment. The aim of this study was to measure the
 risk-benefit ratio of this treatment.Twenty patients with well-controlled diabetes were
 included in a prospective study. In a first pre-injection phase, patients were asked to
 measure glycemia for 7 days, before breakfast and dinner, then 2 hours after lunch and
 dinner. Baseline data including Constant Score (CS), Subjective Shoulder Value (SSV) and
 Numerical Rating Scale (NRS) for pain were collected. Patients were treated with subacromial
 injection with 40mg of Methylprednisolone Acetate and 2ml of Lidocaine. At discharge,
 patients were asked to re-measured glycemia for the following week.
Inclusion Criteria:

 -  Consent to participate in the study.

 -  Severe overall pain and night pain: Numerical Rating Scale (NRS) for pain[8] above or
 equal to 60/100; the scale was modified from 0-10 to 0-100 (0 = no pain 100 =
 unbearable pain).

 -  No significant improvement after at least 2 courses of physiotherapy (including direct
 assistance from a physical therapist with specific exercises, manual therapy, and
 physical agents in order to reduce inflammation and pain).

 -  Clinical signs of subacromial tendinobursitis, with or without signs of rotator cuff
 tear, defined as positive Neer, Yocum and Hawkins tests[9-15]. Pain experienced during
 the execution of these tests needed to reproduce the type of pain that patients
 complained the most.

 -  No indication for surgery due to the age, concomitant comorbidities or patient's
 refusal to undergo surgery.

 -  Well-controlled type-2 diabetes, defined as:

 -  Fasting and pre-prandial blood glucose levels in the range of 90- 150mg/dL.

 -  Hb1Ac <64mmol/mol (corresponding to 8%) measured within 6 months.

 -  A device for self-measurement of blood sugar levels at home

 -  Patients need to have a recent (within 6 months) x-ray and an MRI or ultrasound of the
 affected shoulder

 Exclusion Criteria:

 -  Corticosteroid treatment in the past 3 months.

 -  Complaints of shoulder stiffness more than shoulder pain.

 -  Symptomatic glenohumeral arthritis defined as shoulder stiffness plus moderate
 radiographic signs of arthritis (grade >2 according to Hamada classification and grade
 >1 according to Samilson-Prieto classification for eccentric and concentric arthritis
 respectively).

 -  Shoulder trauma within 3 months of inclusion evaluation for in this study.

 -  High blood pressure values (systolic blood pressure >140mmHg, diastolic blood pressure
 >80mmHg).

 -  Glaucoma.