Background/Purpose: Bursitis is a self-limiting disorder in the majority of patients and typically responds to conservative measures. However, corticosteroid injections may be necessary in recurrent cases. The purpose of this study is to determine the efficacy of corticosteroid injection of methylprednisolone acetate with lidocaine versus lidocaine alone, in addition to celecoxib for subdeltoid and greater trochanteric bursitis in a randomized, double blind, placebo controlled trial.

Methods: 30 patients in our rheumatology clinic with acute or recurrent subdeltoid or trochanteric bursitis were randomized into an experimental group [n=15, 4 subdeltoid and 11 trochanteric bursitis] and a control group [n=15, 4 subdeltoid and 11 trochanteric bursitis]. Subjects with subdeltoid bursitis in the experimental group received methylprednisolone acetate ( long acting) 80 mg (1.0 ml) plus lidocaine 20 mg (2.0 ml) into the subdeltoid bursa. The control group received lidocaine 20mg (2.0 ml) plus normal saline (1.0 ml). Subjects with trochanteric bursitis in the experimental group received methylprednisolone acetate ( long acting) 120 mg (1.5 ml) plus lidocaine 30 mg (3.0 ml); the control group received 30 mg lidocaine plus normal saline (1.5 ml). Each group also received celecoxib 600 mg for the first day ( a 400 mg initial dose followed by 200 mg later in the day) then 200 mg BID for 13 days. All subjects were treated for 14 days.

The primary end point was improvement of VAS (visual analog score) for bursal pain; secondary end points included improvement of VAS for fatigue, sleep, and global function; and bursal tenderness by palpation.

VAS for bursal pain, fatigue, sleep, and global function was scaled from 0 to 10 and bursal tenderness was scaled from 0 to 4.

Results: 30 subjects completed the study with 15 subjects in each group. The primary end point was met, periarticular corticosteroid significantly reduced VAS for bursal pain in experimental group compared to controls). The secondary end points also were met, improvement trends were noted for fatigue, sleep and global function; and bursal tenderness by palpation.

Variables	Treatment Group			Control Group
	Day 0 [Mean SD]	Day 14 [mean (SD)]	% improvement	Day 0 [Mean SD]	Day 14 [mean (SD)]	% improvement
Bursal Pain	6.3 (2.2)	2.3 (2.2)	63	6.6 (2.3)	5.4 (3.0)	18
Fatigue	7.0 (3.2)	4.3 (3.4)	38	6.0 (2.9)	5.5 (3.2)	25
Sleep	6.9 (2.5)	3.0 (2.8)	56	6.3 (2.7)	4.3 (3.3)	31
Global Function	5.8 (2.5)	2.1 (2.0)	63	5.8 (2.2)	4.3 (2.1)	25
Bursal Tenderness ( left shoulder)	1.9 (1.2)	1.4 (0.78)	26	2.0 ( 1.10)	1.75 (1.20)	12
CRP (mg/dl)	0.6 (0.4)	0.6 (0.5)	0	0.6 (0.4)	1.2 (2.3)	-100

Conclusion: Three of four VAS outcomes exceeded 50% improvement in the experimental group, whereas with the control group no VAS outcomes exceeded (31%). Periarticular corticosteroid plus lidocaine in addition to full dose of celecoxib enhances short term benefits of treatment for bursitis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-of-corticosteroid-plus-lidocaine-or-lidocaine-alone-in-patients-receiving-celecoxib-for-the-treatment-of-acute-shoulder-or-trochanteric-bursitis-a-randomized-double-blind-placebo-control/