1000 Section - Comparing Corticosteroid Dosage in the Treatment for Shoulder Impingement Syndrome, A Systematic Review of Randomized Controlled Trials

Tuesday, May 19, 2026

6:00 PM - 7:30 PM PT

Corresponding Author/Autor a quien dirigir la corr(s)

YQ

Yihang Qin, BSc

Medical student
McMaster University
Oakville, Ontario, Ontario, Canada

Co-Author/Coautor(s)

DG

Donna Gao, BASc

Medical Student
McMaster University
Kingston, Ontario, Canada
SC

Seungjae Cho, BSc

Medical student
Temerty Faculty of Medicine, University of Toronto
Toronto, Ontario, Canada

Presenting Author/Autor expositor(s)

YD

Yi (David) Diao, MD

Physical Medicine and Rehabilitation Resident Physician
McMaster University
Burlington, Ontario, Canada

Co-Author/Coautor(s)

AS

Ahilraj Siva, MD

Assistant Clinical Professor
McMaster University
Hamilton, Ontario, Canada

Objectives : Shoulder impingement syndrome is a musculoskeletal pathology that can cause significant pain and impairment despite conservative management. Corticosteroid injection is a common therapeutic method for refractory cases. Apart from two randomized controlled trials (RCTs), there is a paucity of literature that specifically studies how the dosage of corticosteroid impacts the efficacy of the injection. The objectives of this review are to describe the formulations and dosing ranges of corticosteroids used for injections in shoulder impingement and to evaluate potential differences in efficacy across dosing strategies.

Design: Six databases (CINAHL, EMBASE, Ovid MEDLINE, Ovid HealthSTAR, PubMed, Web of Science) were searched from inception to June 29th, 2025. Data on interventional techniques, such as injected steroid concentrations, were collected. Patient-reported pain outcomes, such as visual analogue scale (VAS), and functional scales, such as shoulder pain and disability index (SPADI), were recorded.

Results:
A total of 24 studies comprising 739 patients were included in this review. 7 studies used dose equivalents of less than 40 mg triamcinolone (low dose) while 17 studies used dose equivalents of 40 mg or more (high dose). 13 studies used triamcinolone, 6 used methylprednisolone, 3 used betamethasone and 1 used dexamethasone. The unstandardized mean difference (UMD) in VAS reduction following injection for the low dose group is 2.89 (standard error: 0.03, 95% confidence interval: 2.62-3.16) The UMD for the high dose group is 2.32 (standard error: 0.14, 95% confidence interval: 2.25-2.38).

Conclusion: Both low and high dose injections result in a significant improvement in VAS. The improvement between the low and high doses are not statistically different. Findings of this review complement the conclusions of two RCTs directly comparing corticosteroid doses for shoulder impingement and can serve as a basis for further prospective studies on the doses comparisons for clinical practice.