Subacromial impingement syndrome: effectiveness of pharmaceutical interventions-nonsteroidal anti-inflammatory drugs, corticosteroid, or other injections: a systematic review

Arch Phys Med Rehabil. 2013 May;94(5):961-76. doi: 10.1016/j.apmr.2012.11.041. Epub 2012 Dec 12.


Objective: To present an evidence-based overview of the effectiveness of pharmaceutical interventions, including nonsteroidal anti-inflammatory drugs, corticosteroid injections, and other injections, used to treat the subacromial impingement syndrome (SIS). An overview can help physicians select the most appropriate pharmaceutical intervention, and it can identify gaps in scientific knowledge.

Data sources: The Cochrane Library, PubMed, Embase, PEDro, and CINAHL databases.

Study selection: Two reviewers independently selected relevant reviews and randomized clinical trials.

Data extraction: Two reviewers independently extracted the data and assessed the methodologic quality.

Data synthesis: A best evidence synthesis was used to summarize the results. Three reviews and 5 randomized clinical trials were included. Although we found limited evidence for effectiveness in favor of 2 sessions with corticosteroid injections versus 1 session, for the effectiveness of corticosteroid injections versus placebo, nonsteroidal anti-inflammatory drugs, or acupuncture, only conflicting and no evidence for effectiveness was found. Moderate evidence was found in favor of immediate release oral ibuprofen compared with sustained-released ibuprofen in the short-term. Also, moderate evidence for effectiveness was found in favor of glyceryltrinitrate patches versus placebo patches in the short-term and mid term. Furthermore, injections with disodium ethylene diamine tetraacetic acid plus ultrasound with ethylene diamine tetraacetic acid gel were more effective (moderate evidence) than was placebo treatment in the short- and long-term.

Conclusions: This article presents an overview of the effectiveness of pharmaceutical interventions for SIS. Some treatments seem to be promising (moderate evidence) to treat SIS, but more research is needed before firm conclusions can be drawn.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Administration, Cutaneous
  • Administration, Oral
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / therapeutic use*
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Chelating Agents / therapeutic use
  • Edetic Acid / therapeutic use
  • Humans
  • Ibuprofen / therapeutic use
  • Injections, Intra-Articular
  • Nitroglycerin / therapeutic use
  • Shoulder Impingement Syndrome / drug therapy*
  • Ultrasonic Therapy
  • Vasodilator Agents / therapeutic use


  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents, Non-Steroidal
  • Chelating Agents
  • Vasodilator Agents
  • Edetic Acid
  • Nitroglycerin
  • Ibuprofen