A comparison of the effectiveness of lateral versus posterior approach to shoulder injection in patients with subacromial impingement syndrome: A pragmatic randomized controlled trial

Abstract

Objective The aim of the study was to determine the effectiveness of the lateral approach to subacromial injection, compared with the posterior approach, for the treatment of subacromial impingement syndrome. Method A pragmatic randomized controlled trial was carried out in an outpatient community musculoskeletal service. The sample comprised 80 adults, aged 18 years or over, with subacromial impingement syndrome. The intervention group received a single subacromial injection, using a 21‐gauge green needle, of 40 mg/ml triamcinolone acetonide (Kenalog) and 4 ml 1% lignocaine using a lateral approach. The control group received identical treatment, with the exception that the injection was given using a posterior approach. The outcome measures were pain measured using 0–10 numerical pain scale and shoulder pain and disability index (SPADI) scores at 8 and 12 weeks' follow‐up. Result A moderate but statistically and clinically significant difference in improvement in daytime pain (mean change in score) occurred in favour of the lateral group (mean = 4.0) compared with the posterior group (mean = 2.0) between weeks 0 and 8 (1.4 points [95% confidence interval 0.3, 2.6; p = 0.018]). However, there were no statistically significant differences between the groups in night‐time pain, shoulder function and SPADI scores. There was a statistically and clinically significant difference (p = 0.001) within the groups for all clinical outcomes between weeks 0 and 8, and between weeks 0 and 12. Conclusion There were no significant differences in the treatments; however, both forms of treatment were associated with a significant improvement in shoulder pain, function and disability.

Comparison of the Effectiveness of the Ultrasound- Guided Subacromial, Acromioclavicular with Subacromial Injection and Suprascapular Nerve Block in Patients with Shoulder Subacromial Impingement Syndrome: A Randomized Controlled, Single Blind, Clinical T

“…Different opinions have been reported about the efficacy of SA injection in studies where the combination of local anesthetic and CS is performed. 13,18,19 While some of these studies reported that methylprednisolone treatment injected into the SA cavity did not affect pain and functional recovery during the 12week follow-up period, 2 different studies concluded that SA injections were effective. 13,18 In one of these studies, Ogbeivor et al reported that VAS and SPADI values were found to be significantly lower at the end of 12 weeks.…”

“…13,18 In one of these studies, Ogbeivor et al reported that VAS and SPADI values were found to be significantly lower at the end of 12 weeks. 19 On the other hand, Sumanont et al emphasized that although the CS injection on the shoulder region provided an acceptable reduction in pain and improvement in functional outcomes, the current literature in this area was insufficient. 2 In our study, with the literature, we found that the efficacy of the injection decreased after the 12 th week in the group that received only SA injection.…”

The Importance of Pragmatic over Explanatory Randomised Controlled Trial in Musculoskeletal Physiotherapy Practice

“…The nine dimensions for assessing the level of pragmatism in a trial, as proposed in the pragmatic-explanatory continuum indicator summary 2 (PRECIS-2) tool (Adopted from Loudon et al, 2015) used in a pragmatic RCT in a community MSK trial on shoulder pain (Ogbeivor et al, 2019).…”

Comparison of the Effectiveness of Isometric, Isotonic Eccentric And Isotonic Concentric Exercises in Pain Management

“…Subacromial Impingement Syndrome results in decreasing range of motion and affecting the functional capabilities and quality of life of the patient 4 . The pain specifically in the anterolateral acromial area is the most typical sign of subacromial impingement syndrome, which radiations maybe felt up to the lateral side of mid portion of humerus bone 5 .…”