Injection of the subacromial-subdeltoid bursa: blind or ultrasound-guided?

Abstract

Blind injection into the SSB is as reliable as US-guided injection and could therefore be used in daily routine. US-guided injections may offer a useful alternative in difficult cases, such as with changed anatomy postoperatively or when there is no effective clinical outcome.

Positive outcomes with intra-articular glenohumeral injections are independent of accuracy

“…Most injections are performed blindly in the clinic, undoubtedly contributing to the wide range of accuracies reported in the literature. 12,16,23,30,34,42 We found no significant difference in outcomes between groups, whether the corticosteroid injection was noted to be in or out of the glenohumeral joint (Table II). These findings corroborate prior studies that demonstrated improvement in the symptoms associated with shoulder pathology, whether the injection was noted to be in the targeted structure or not.…”

“…Furthermore, there has been a large variance of the accuracy of injections reported in the literature. 12,30,34,36,42 With the understanding that shoulder pain is prevalent and the continued controversy over the importance of the accuracy of injection, we determined to examine the accuracy of intraarticular injections and the effect of that accuracy on pain and functional outcomes in patients with various shoulder pathologies.…”

A Randomized Comparative Study of Blind versus Ultrasound Guided Glenohumeral Joint Injection of Corticosteroids for Treatment of Shoulder Stiffness

“…However, there were no further significant differences in improvement between the two groups beyond the third week. Rutten et al, 16) who compared the accuracy of both anterior and posterior blind injection to that of US-guided injection into the subacromial-subdeltoid bursa using T1-weighted magnetic resonance (MR) scan immediately after injection, reported that the accuracy of blind and US-guided injection was the same and that blind injection is as reliable as US-guided injection. However, they did not compare the clinical outcomes in between groups.…”

Methicillin-resistant Staphylococcus aureus infection of the subacromial bursa: an unusual complication following subacromial corticosteroid injection (a report of two cases)

“…1 Associated risks of subacromial injection include bleeding, allergic reaction, tendon rupture, muscle necrosis, osteomyelitis and infection. 2,3 It is rare to develop infection or septic arthritis following shoulder injections and Staphylococcus aureus is usually the most common causative organism. 4,5 To date, there has only been one reported case series of four patients with methicillin-resistant S. aureus (MRSA) injection-induced pyogenic arthritis of the shoulder joint.…”