***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A double-blind , parallel trial of 40 patients with chronic shoulder pain was carried out to compare alleviation of pain and improvement in mobility after treatment with 20 mg piroxicam each morning or 250 mg naproxen twice daily . During the 3-week study , patients also underwent conservative treatment of therapeutic exercise . Piroxicam was better than naproxen at relieving pain at night , but time , rather than a drug effect , seemed responsible for the improvement in shoulder abduction . No difference between the drugs was demonstrated regarding their effect on pain on active movement of the shoulder and external rotation Objectives : To evaluate the short-term symptomatic efficacy of rofecoxib and diclofenac versus placebo in acute episodes of shoulder pain . Design : R and omized controlled trial of 7 days . Setting : Rheumatologists and /or general practitioners totaling 47 . Participants : Acute shoulder pain . Interventions : Rofecoxib 50 mg once daily , diclofenac 50 mg three times daily , and placebo . Outcome measures : Pain , functional impairment , patient 's global assessment of his/her disease activity , and local steroid injection requirement for persistent pain . The primary variable was the Kaplan-Meier estimates of the percentage of patients at day 7 fulfilling the definition of success ( improvement in pain intensity and a low pain level sustained to the end of the 7 days of the study ; log-rank test ) . Results : There was no difference in the baseline characteristics between the three groups ( rofecoxib n = 88 , placebo n = 94 , and diclofenac n = 89 ) . At day 7 , the Kaplan-Meier estimates of successful patients was higher in the treatment groups than in the placebo ( 54 % , 56 % , and 38 % in the diclofenac , rofecoxib , and placebo groups respectively , p = 0.0070 and p = 0.0239 for placebo versus rofecoxib and diclofenac , respectively ) . During the 7 days of the study , there was a statistically significant difference between placebo and both active arms ( rofecoxib and diclofenac ) in all the evaluated outcome measures A local steroid injection had to be performed in 33 ( 35 % ) and 19 ( 22 % ) patients in the placebo and rofecoxib group respectively . Number needed to treat to avoid such rescue therapy was 7 patients ( 95 % confidence interval 5–15 ) . Conclusion : This study highlights the method ological aspects of clinical trials , e.g. , eligibility criteria and outcome measures , in acute painful conditions . The data also establish that diclofenac and rofecoxib are effective therapies for the management of acute painful shoulder and that they reduce the requirement for local steroid injection OBJECTIVE Shoulder tendinitis and subacromial bursitis are acute , painful inflammatory musculoskeletal conditions that may recur as a result of overuse . We investigated the efficacy of celecoxib in managing patients with acute shoulder tendinitis/bursitis . METHODS In this double blind , placebo controlled , parallel group study , patients with acute onset shoulder tendinitis and /or subacromial bursitis were r and omized to receive one of : celecoxib 400 mg followed by 200 mg bid , naproxen 500 mg bid , or placebo bid for 14 days . The primary measure of efficacy was the mean reduction in Maximum Pain Intensity at Rest , measured using a 100 mm visual analog scale , from baseline to Days 7 and 14 . RESULTS Of the 306 patients r and omized to treatment , 254 completed the study . On Day 7 , the mean reduction from baseline in Maximum Pain Intensity at Rest was significantly greater in the celecoxib group compared with the placebo group ( -27.7 + /- 2.75 mm vs -18.4 + /- 2.63 mm , respectively ; p < 0.05 ) . Similarly , on Day 14 , the mean reduction from baseline in Maximum Pain Intensity at Rest was greater in the celecoxib group compared with placebo ( -35.0 + /- 3.06 mm vs -25.0 + /- 3.05 mm ; p < 0.05 ) . The mean reduction from baseline in Maximum Pain Intensity at Rest was also greater in the naproxen group compared with the placebo group at Day 7 ( -26.4 + /- 2.70 mm vs -18.4 + /- 2.63 mm ; p < 0.05 ) , but not on Day 14 . Secondary measures of efficacy also showed treatment with celecoxib to be significantly better than placebo treatment and similar to treatment with naproxen . In addition , celecoxib was well tolerated in these patients . CONCLUSION Celecoxib showed comparable efficacy to naproxen in relieving the pain of patients with acute shoulder tendinitis and /or subacromial bursitis Using a prospect i ve , double blind , double dummy protocol , we compared the efficacy of subacromial injection of 40 mg of triamcinalone acetonide versus oral indomethacin , 100 mg/day , in 40 patients with acute rotator cuff tendinitis . Repeat injection and refill of medication was given after 3 weeks , if necessary . At 6 weeks , there was no significant difference between the 2 groups with respect to the percentage of patients who improved ( 60 vs 66 % ) or the magnitude of the change of pain and motion variables . This study suggests that there is essentially no difference in the short term efficacy of oral nonsteroidal therapy compared to local corticosteroid injection(s ) in the treatment of rotator cuff tendinitis Background Tendon injuries that occur at the osteotendinous junction are commonly seen in clinical practice and range from acute strain to rupture . Nonsteroidal anti-inflammatory drugs are often prescribed in the treatment of these conditions , but the effect that these agents may have on the healing response at the bone-tendon junction is unclear . Hypothesis In response to an acute injury at the osteotendinous junction , the healing patellar tendon will have inferior biomechanical properties with administration of anti-inflammatory drugs as compared with acetaminophen and control . Study Design Controlled laboratory study . Methods A total of 215 Sprague-Dawley rats underwent transection of the patellar tendon at the inferior pole of the patella , which was subsequently stabilized with a cerclage suture .  The animals were then r and omized into 7 groups and administered 1 of the following analgesics for 14 days ibuprofen , acetaminophen , naproxen , piroxicam , celecoxib , valdecoxib , or control . At 14 days , all animals were sacrificed , and the extensor mechanism was isolated and loaded to failure . Biochemical analysis of the repair site tissue was performed . Animal activity throughout the study was monitored using a photoelectric sensor system . Results The control group demonstrated greater maximum load compared with the celecoxib , valdecoxib , and piroxicam groups ( P < .05 ) . The acetaminophen and ibuprofen groups were also significantly stronger than the celecoxib group ( P < .05 ) but not statistically different than the control group . A total of 23 specimens had failure of the cerclage suture with the following distribution control ( 0/23 ) , ibuprofen ( 0/23 ) , acetaminophen ( 0/24 ) , naproxen ( 3/24 ) , piroxicam ( 4/24 ) , celecoxib ( 6/22 ) , and valdecoxib ( 10/24 ) . The difference in distribution of the failures was significant ( P < .001 ) . Conclusions Anti-inflammatory drugs , with the exception of ibuprofen , had a detrimental effect on healing strength at the bone-tendon junction as demonstrated by decreased failure loads and increased failures of the cerclage suture . Acetaminophen had no effect on healing strength . The biomechanical properties paralleled closely with the total collagen content at the injury site , suggesting that these agents may alter healing strength by decreasing collagen content . Clinical Relevance Selective and nonselective cyclooxygenase ( COX ) inhibitors should be used judiciously in the acute period after injury or surgical repair at the bone-tendon junction This study compared the analgesic efficacy and safety of the cyclo-oxygenase-2 specific inhibitor celecoxib with the non-specific non-steroidal anti-inflammatory drug , naproxen , in patients with acute shoulder pain . Adult patients with shoulder pain , onset within the previous 14 days and shoulder pain of ≥ 40 mm on a 100 mm visual analogue scale ( VAS ) , were treated with oral doses of celecoxib or naproxen for 14 days and followed by a visit at day 42 in a double-blind , r and omized study . The primary efficacy assessment was change in maximum pain at rest on a 100 mm VAS at day 14 compared with baseline . In addition , secondary efficacy pain and functional assessment s were analysed at baseline , day 14 and day 42 . A total of 202 patients were included in the trial ( 99 celecoxib 400 mg/day ; 103 naproxen 1 g/day ) . The difference in change from baseline at day 14 in maximum pain at rest was not statistically significant between the two treatment groups , but was numerically higher for celecoxib than for naproxen ( −47.9 ± 2.5 versus −42.3 ± 2.5 , respectively ) . According to the limits of the 95 % confidence interval of the difference between groups ( −12.52 ; 1.38 ) , celecoxib appeared to be at least as effective as naproxen . All secondary efficacy measures followed the same pattern , showing similarity between the two treatments with a trend in favour of celecoxib . The incidences of adverse events were similar for both groups . Fewer patients experienced epigastric pain  with celecoxib ( seven patients versus 14 with naproxen ) . This adverse event led to discontinuation in two patients receiving celecoxib and five receiving naproxen . Celecoxib 400 mg/day was at least as effective as naproxen 1 g/day in managing pain in this condition 30 patients with supraspinatus or bicipital tendonitis were r and omly allocated to active infrared laser therapy at 904 nm three times weekly for 2 weeks , dummy laser or drug treatment for 2 weeks . Objective ly maximum active extension , flexion and abduction of the shoulder , and subjectively pain stiffness movement and function were measured at 0 and 2 weeks . Significant improvement of active over dummy laser was noted for all seven assessment s. Active laser therapy produced significant improvement over drug therapy for all three objective measures and pain . Naproxen sodium significantly improved only movement and function compared to dummy laser . These results demonstrate the effectiveness of laser therapy in tendonitis of the shoulder Summary This was a double-blind study design ed to compare the efficacy and tolerability of diclofenac/misoprostol and diclofenac in patients with acute tendinitis/bursitis of the shoulder .  Diclofenac 50mg/misoprostol 200μg  ( n=185 )  or diclofenac 50 mg ( n=187 ) was administered twice or 3 times daily for 14 days . Various physician ’s and patient ’s assessment s performed during and at the end of treatment showed similar improvements with both treatments . Abdominal pain , nausea and vomiting occurred somewhat more frequently with diclofenac/misoprostol , but patient withdrawals due to adverse events did not differ markedly between the groups . Thus , in the short term treatment of acute tendinitis/bursitis of the shoulder diclofenac/misoprostol  possesses efficacy similar to that with diclofenac alone and provides the gastroprotective benefit  of misoprostol . Previous studies in Osteoarthritis and rheumatoid arthritis have established diclofenac/misoprostol to be as effective as diclofenac but with significantly less gastrointestinal damage ( Verdickt et al. 1992 The effect of triamcinolone subacromial bursa injection versus naproxen therapy was compared in a r and omized , double-blind , placebo-controlled  study of 100 patients who had painful shoulders . Outcome was compared using degree of active abduction , pain , limitation of function , and a clinical index that combined equally weighted measures of all of these . In a time-adjusted analysis , triamcinolone was superior to placebo in all clinical variables . Naproxen was superior to placebo in all variables except pain .  Triamcinolone was superior to naproxen in the relief of pain ( P = 0.04 ) and the clinical index ( P = 0.04 ) . Multiple linear regression analysis showed that naproxen and triamcinolone treatment accounted for only 16 % of the variation in outcome , compared with 44 % accounted for by the clinical index prior to treatment . Thus , patients with a poor pretreatment clinical index ( those with the most room for improvement ) were least likely to improve . We conclude that both triamcinolone ( P = 0.00005 ) and naproxen ( P = 0.02 ) are superior to placebo in the treatment of the painful shoulder Summary In order to compare the efficacy and tolerance of two drug formulations of ibuuprofen , conventional tablets 600 mg QID ( CI ) and sustained-release tablets 1200 mg BID ( SRI ) , a total of 147 patients in 7 centres in Denmark with nontraumatic shoulder pain were included in a double-blind dummy study . Initially 
    Output:
    
Low to moderate grade evidence exists regarding the efficacy of non-steroidal anti-inflammatory drugs for rotator cuff tendinopathy .
Oral anti-inflammatory drugs are effective in reducing short-term pain but not function .
In terms of pain and function , oral anti-inflammatory drugs in the short term are as effective as corticosteroid injections