Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms

Abstract

Objective-To study the eVect of accuracy on the clinical outcome of local steroid injections to the shoulder. Methods-37 patients with shoulder symptoms of at least two months' duration received local injections of a mixture of triamcinolone and radiographic contrast material using a standardised technique. Radiographs of the joint were taken immediately afterwards. Details of the patients' symptoms (assessed by visual analogue scales) and range of movement at the joint were obtained before and two weeks after the injection. At follow up the patients were also assessed by means of a five point global rating scale of maximum and current benefit. Results-14 of the 38 procedures (37%) were judged to be accurately placed: four of the 14 attempted subacromial injections (29%) and 10 of the 24 attempted glenohumeral injections (42%). There were significant diVerences in relation to outcome between the accurately placed and the inaccurately placed groups. Conclusions-Accuracy of steroid placement by injection in patients with shoulder symptoms may significantly aVect the clinical outcome.

A physiotherapy perspective of musculoskeletal imaging in sport

“…This is now a relevant issue for physiotherapists as many working in an extended scope role in the NHS are now performing injections. It has been documented that 14-71% of injections carried out ''blind''-without image guidance-miss their target [23][24][25][26][27]. What we do not know is whether this makes a difference in clinical efficacy.…”

“…It is perhaps because of these concerns and the improved technology that ultrasound is an increasingly popular technique to ensure accuracy of softtissue injection in sports medicine for medical staff and physiotherapists [28]. Eustace et al [24] report improved outcomes in shoulder pain in accurately placed subacromial and glenohumeral injections. Nevertheless, some have suggested that ultrasound guidance does not make a difference in long-term efficacy [29,30].…”

Comparison of High- and Low-Dose Corticosteroid in Subacromial Injection for Periarticular Shoulder Disorder: A Randomized, Triple-Blind, Placebo-Controlled Trial

“…5,9,[12][13][14]46 One reason for such differences possibly can be related to variability in the accuracy of injected corticosteroid placement. For example, the success rate of blinded subacromial injection varied greatly from 29% to 83% depending on injection methods and operators, [47][48][49][50] with better treatment effect from corticosteroids more accurately injected into the subacromial bursa. 9,15,51 With recent advances in diagnostic ultrasound in musculoskeletal medicine, ultrasound-guided injections have become prevalent.…”

Radiological interventions for soft tissue injuries in sport

“…There is good evidence that ultrasound enables a more accurate delivery of the pharmacological agent at the correct anatomical site. Blind subacromial injections are intrabursal in only 7-29% of cases [2][3][4][5]. However, the impact on therapeutic effect is controversial.…”

“…External impingement of the shoulder associated with subacromial bursitis may be effectively treated by intrabursal injection of steroid and anaesthetic [2]. It is common practice to use volumes of at least 10 ml to fill the bursa in an attempt to break down bursal adhesions.…”