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Shoulder Pain: Randomised trial of Injectable Treatments) A randomised feasibility and pilot study of Autologous Protein Solution (APS) vs Corticosteroids for treating subacromial shoulder pain


Shoulder pain is very common, and accounts for thousands of appointments in general practice and hospitals each year in the UK. The most common reason for this pain is inflammation to the tissues just below the outside of the shoulder. Over the years, many different treatments have been tried to treat this pain. The most common treatments that we use currently are steroid injections combined with physiotherapy, or keyhole surgery.

Recently, there have been questions about whether using steroid injections is actually safe in the long term. There are concerns that they may affect tendons (the tissue that connect muscles to your bones) or contribute to the development of arthritis. At the same time, some research suggests that our operations may also not be as effective for shoulder pain as previously thought. As such, healthcare workers have to look for other safe and effective treatment options for this painful condition.

Laboratory studies have shown that painful shoulders often go together with poor tendon health and inflammation. This had led to recent improvements in injection treatments. These new injections aim to help tendons repair themselves and so reduce inflammation and pain. These are termed 'biologic' injections. Whilst the theory behind these injections is good, and they have been found to be safe, no one has conducted a trial to see if the treatments are more or less effective than steroid injections. We would like to perform a trial to compare one of these biologic-injection treatments against steroid injections. The injection we aim to test involves us taking a sample of the person s blood. We would then take out some of the most useful parts of the blood and inject it back into the shoulder to aid healing. The patient will then receive physiotherapy as normal, regardless of what injection they have. Before we can conduct a full large study, we need to do this smaller study to see how quickly we can recruit patients and whether the patients and doctors are happy with the how the trial works. In this trial we will recruit 50 patients. We will ask patients to join the trial who have already been referred to us for shoulder pain and are about to start normal treatment for this. If they decide to join the trial the only change in their treatment will be the difference in the type of injection they receive. If our study is successful we will then conduct a larger trial to see whether the new type of injection is better than steroids for shoulder pain. If this turns out to be the case then our trials could help large numbers of patients in the NHS with this painful condition.

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