Subacromial Corticosteroid Injection Research Articles

A comparative study of intraarticular versus subacromial corticosteroid injection in the treatment of frozen shoulder

Background: Frozen shoulder or adhesive capsulitis, is a condition characterized by pain and restricted movement of the shoulder joint. Corticosteroid injections are commonly used to alleviate symptoms, but the optimal injection site remains debated. This comparative study aims to evaluate the efficacy of intraarticular versus subacromial corticosteroid injections in treating frozen shoulder. Methods: This prospective, randomized controlled study was conducted over 12 months, from November 2022 to October 2023, at BMCRI, Bangalore. A total of 60 patients diagnosed with adhesive capsulitis were enrolled and randomized into two groups: 30 patients in the intraarticular (IA) injection group and 30 patients in the subacromial (SA) injection group. Patients were randomly assigned to either the IA group or the SA group. The IA group received a 40 mg injection of Triamcinolone Hexacetonide with 4 ml of 2% lidocaine into the glenohumeral joint. SPSS (Version 25.0) was used for analysis. Results: Patients in the intraarticular group demonstrated significantly lower pain scores compared to those in the subacromial group at the 4th, 8th and 12th weeks (p<0.05). The intraarticular group consistently achieved higher Constant Shoulder Scores at 4, 8 and 12 weeks, suggesting a more effective recovery in shoulder function compared to the subacromial group. Conclusion: This study demonstrates that intraarticular corticosteroid injections are more effective than subacromial injections in treating patients with frozen shoulders, particularly in terms of pain relief and functional improvement.

Ultrasound-guided percutaneous lavage for the treatment of rotator cuff calcific tendinopathy: a systematic review with meta-analysis of randomized controlled trials.

Ultrasound-guided lavage (UGL) is a minimally invasive percutaneous treatment for rotator cuff calcific tendinopathy (RCCT). It involves the use of a syringe containing saline and/or anesthetic solution injected directly into the calcification allowing aspiration of the fragmented calcific material. The aim of this systematic review is to investigate if UGL is effective in improving pain, function, quality of life, range of motion (ROM), and in promoting complete resorption of calcifications in patients with RCCT. Only randomized controlled trials considering people diagnosed with RCCT, at any stage and at any time of the onset of symptoms treated with UGL, were included. Embase, CENTRAL, CINHAL, PEDro and MEDLINE were explored up until May 2024. Two independent authors selected randomized controlled trials by title and abstract; afterwards, the full text was thoroughly evaluated. The risk of bias (ROB) was assessed using the Cochrane risk of bias 2 (ROB2) tool and the certainty of evidence was evaluated through the GRADE approach. Seven studies (709 subjects) were included. Overall, three studies were judged as low risk of bias. Pooled results showed non-significant differences between UGL and extracorporeal shock-wave therapy (ESWT) at 12 weeks (SMD=-0.52, 95% CI -1.57, 0.54, P=0.34, I2=93%) and at 26 weeks (MD=-1.20, 95% CI -2.66, 0.27, P=0.11, I2=82%), while a significant difference favoring UGL (SMD=-0.52, 95% CI -0.85, -0.19, P=0.002, I2=38%) resulted at 52 weeks. In regard to function, pooled results showed non-significant difference between UGL and ESWT at 6 weeks (MD=3.34, 95% CI -11.45, 18.12, P=0.66, I2=79%) and at 52 weeks (SMD=0.10, 95% CI -0.40, 0.60, P=0.69, I2=30%). Considering the rate of resorption of calcifications between UGL combined with subacromial corticosteroid injection (SCI) versus injection alone, pooled results showed significant difference favoring UGL at <52 weeks (RR=1.63 95% CI 1.34, 1.98, P<0.00001, I2=0%). Certainty of evidence ranged from low to very low. UGL seems to be a reasonable and safe treatment for RCCT, however compared to other non/mini-invasive approaches, UGL showed doubtful results in controlling pain and increasing function and rate of calcifications resorption. These results should be interpreted with caution because certainty of evidence ranged from low to very low.

Nonsteroidal Anti-Inflammatory Drug Injections versus Steroid Injections in the Management of Upper and Lower Extremity Orthopedic Conditions: A Systematic Review with Meta-Analysis.

Although corticosteroid injections are an effective treatment for musculoskeletal pathologies, they may not be suitable for all patients. The purpose of this systematic review was to compare clinical outcomes between patients who received NSAID and corticosteroid injections for various orthopedic conditions. Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched, and meta-analyses were performed using a random-effects model for outcomes presented in three or more studies. Other studies were qualitatively analyzed. A total of 28 articles with 2113 patients were included. A meta-analysis of five studies in patients with shoulder impingement syndrome demonstrated that there was no significant difference in the pain visual analogue scale (VAS) between subacromial NSAID injections and corticosteroid injections at 1 month [weighted mean difference (WMD) -0.244; 95% CI, -1.232 to 0.745; I2, 94.5%]. For patients with knee osteoarthritis, a meta-analysis of three studies demonstrated that there was no significant difference between intraarticular NSAID injections and corticosteroid injections in pain VAS at 1 month (WMD 0.754; 95% CI, -0.413 to 1.921; I2, 90.2%) and 3 months (WMD-0.089; 95% CI, -0.345 to 0.166; I2, 0%). A review of the studies assessing pain outcomes for hip osteoarthritis, adhesive capsulitis, and plantar fasciitis showed no significant differences between the NSAID and corticosteroid groups. NSAID injections may be safe and effective alternatives to steroid injections, especially in shoulder impingement syndrome and knee osteoarthritis.

Arthroscopic Repair of Rotator Cuff Tears in Older Adults: A Retrospective Case-Series Study.

Rotator cuff tears (RCTs) are a common source of pain in the shoulder girdle. There is still debate about the optimal treatment for older adults with RCTs. In clinical practice, patients who do not respond well to non-surgical management may still be eligible for operative treatment. In this study, we assessed the outcome of arthroscopic repair of RCTs in patients ≥60 years old. A retrospective case series was conducted to include patients who underwent arthroscopic repair of RCTs from 1 January 2018 to 1 January 2021. The study included individuals aged ≥60years who had radiologically confirmed RCTs (verified by MRI) and clinical findings including sleep-disturbing pain and reduced range of motion. Preoperative treatment included physiotherapy for at least 6months and one subacromial corticosteroid injection. Fifty-three RCTs were treated during the study period. After exclusion because of incomplete documentation, 45 patients remained. The mean age was 66years and 80% had isolated supraspinatus tears and 25% had variable degrees of fatty infiltration (Goutallier grade 1-3) on MRI examination with positive tangent sign. There were no surgical site infections and three symptomatic re-ruptures (6%). At follow-up, (71%) reported no remaining sleep-disturbing shoulder pain. Abduction improved from 62° to 122°. Flexion improved from 68° to 135°. This study found that people aged 60years and older who underwent repair of RCTs showed statistically significant clinical improvement in shoulder flexion and abduction with less sleep-disturbing shoulder pain. These encouraging results may contribute to the existing literature, favoring the choice of surgical treatment for symptomatic RCTs in this age group with failed nonoperative treatment. The arthroscopic repair of RCTs in patients 60years and older yielded a substantial increase in shoulder flexion and abduction, significantly reducing sleep-disturbing shoulder pain. Postoperative complications were minimal.

Investigation of the effect of subacromial corticosteroid injections on intraocular pressure

Background: Subacromial corticosteroid injection is one of the most commonly used procedures to treat subacromial impingement syndrome. Despite their significant efficacy, corticosteroids have several serious adverse effects, including increased intraocular pressure (IOP) and visual loss. The purpose of this study is to determine the effect of subacromial corticosteroid injections on IOP. Materials and Methods: 42 patients with impingement syndrome, who received subacromial corticosteroid injection, were included in the study. Patients received a single dose of betamethasone. IOP was monitored using a tonometer prior to injection, 24 hours after injection, and one week following injection. Results: The average age of the patients was 52.1±9.0, and 31 (74%) of them were female. Patients’ mean IOP values were 16.0±2.6 mmHg, 16.4±2.4 mmHg, and 16.1±2.31 mmHg before injection, one day after injection, and one week after injection, respectively. Repeated ANOVA tests revealed no statistically significant difference between the three measurements (P=0.386). Age, gender, history of diabetes, and history of hypertension didn’t have a significant effect on IOP change after corticosteroid injection. Those with a family history of glaucoma had a significantly greater increase in IOP on day 1 post-injection than those without (P=0.05). Conclusions: This is the first study to examine the effect of subacromial corticosteroid injections on IOP change. While a single subacromial steroid injection has no statistically significant effect on IOP change, care should be taken, particularly in susceptible individuals and those who need repeated injections.

Ultrasound-guided rotator interval or subacromial corticosteroid injection in primary adhesive capsulitis of the shoulder: Does it make a difference?

Primary adhesive capsulitis occurs spontaneously without any predisposing factors. Diabetes, diseases of thyroid, cerebrovascular accident, coronary artery diseases, autoimmune disease and Dupuytren’s contracture are some of the associated conditions. Various treatment methods for adhesive capsulitis of shoulder including physical therapy, intraarticular corticosteroid injections, manipulation under anaesthesia, and arthroscopic or open capsular release have been described. Intra-articular, subacromial, rotator interval and bicipital grove are the various sites for corticosteroid injection in adhesive capsulitis. Ultrasound has been used widely in shoulder joint injections to improve accuracy. There is limited data comparing these sites for their efficacy in adhesive capsulitis when injected under ultrasound guidance. In this study, we compared ultrasound-guided corticosteroid injection through rotator interval and subacromial route shoulder joint in adhesive capsulitis of shoulder.

A prospective study of 100 patients with rotator cuff tendinopathy showed no correlation between subacromial bursitis and the efficacy of ultrasound-guided corticosteroid injection.

The objective of this study was to determine whether the presence of subacromial bursitis in patients with rotator cuff tendinopathy (RCT) was associated with a better outcome after ultrasound (US)-guided subacromial corticosteroid injection. A single-center prospective study was performed including patients referred for subacromial injection to manage RCT. At baseline, all patients received an US-guided intra-bursal injection of betamethasone (1ml). The primary endpoint was reduced pain 3months (M3) after the procedure: a good responder was defined by a decrease in Visual Analogue Scale pain of more than 30%. Secondary endpoints included functional recovery assessed by the Oxford Shoulder Score (OSS) and clinical success at 6weeks (W6). We also explored the association between good clinical response and other factors, such as US or X-ray features. One hundred patients were included and 49 presented with subacromial bursitis. At M3, 60% of patients (54/100) were considered good responders. The rate of good responders did not differ between the bursitis and non-bursitis groups (p = 0.6). During follow-up, OSS improved over time whether bursitis was present or not. We did not find any US or X-ray features significantly associated with a favorable clinical outcome. The presence of subacromial bursitis did not influence clinical outcomes at 3months post-subacromial injection in patients suffering from RCT. The presence of subacromial bursitis did not influence clinical outcomes at 3months post-subacromial corticosteroid injection in patients with rotator cuff tendinopathy. For patient management, looking for ultrasonographic signs of bursitis does not appear relevant for the indication of the injection. • Ultrasound-guided subacromial corticosteroid injections led to a significant improvement in 60% of patients suffering from rotator cuff tendinopathy. • The presence of subacromial bursitis was not associated with better improvement at 3months post-injection. • Except for the Minnesota score referring to job satisfaction, we did not find any baseline clinical, X-ray, or ultrasound characteristics associated with a successful outcome.

Poster 101: Evaluation of Novel Treatment Agents on Rotator Cuff Tendon and Muscle Pathology in a Murine Subacromial Impingement Model

Poster 101: Evaluation of Novel Treatment Agents on Rotator Cuff Tendon and Muscle Pathology in a Murine Subacromial Impingement Model

Poster 177: Does Prior Ipsilateral Steroid Injection Affect Outcomes After Rotator Cuff Repair?

Objectives: Rotator cuff pathology is a common problem, affecting approximately 17 million individuals in the US. Among professional and competitive athletes, only 49.9% have returned to play at the same level as before their injury. Initial treatment often includes corticosteroid injections, but some patients continue to have pain resulting in surgical treatment. Although steroids are the mainstay of conservative treatment, recent studies have shown concerns for increased rates of postoperative infections and revision surgeries after RCR. This study aimed to determine the effect of prior ipsilateral steroid injection on outcomes following arthroscopic rotator cuff repair. Methods: A retrospective chart review was performed on 295 patients who underwent rotator cuff repair by a single fellowship-trained orthopedic surgeon from 2017-2019. Of the 225 patients that met inclusion criteria and underwent analysis, 42 patients were in the injection group (IG) and 183 in the control group (CG). Demographics, range of motion (ROM), patient-reported pain and satisfaction (0- 10), subjective shoulder value (SSV), complications and reoperations were compared between groups. Delta ROM and strength were defined as postoperative ROM minus preoperative ROM. Complications were defined as reoperations, retears, or subsequent infection. Statistical analysis included chi-square and student t-tests. Results: The cohort consisted of 57.4% males with an average age of 58.3, BMI of 29.5, and mean follow-up of 7.3 months. The mean time from injection to surgery was 5.6 months. There were no significant differences in demographics between the injection and control group. Preoperatively, the injection group had a significantly greater median supraspinatus strength (p=0.002), summed strength (p=0.003), forward elevation (p=0.003), abduction (p=0.005), and active external rotation (p&lt;0.001). This was specific to injections received within the 12 months before surgery. Postoperatively, there were no significant differences between the groups on measures of pain, shoulder function, shoulder strength, range of motion, or SSV. The frequency of complications was also comparable between the no injection and injection group, having similar rates of persistent pain, limited ROM or stiffness, numbness or tingling, weakness, cervicalgia, adhesions, retear, and upper extremity DVT, and postoperative infections. Conclusions: The results of our study indicate that ipsilateral shoulder injection within one year of arthroscopic rotator cuff repair improves preoperative functional outcomes, namely improvements in forward flexion, abduction, external rotation, and relative strength. Despite enhancements preoperatively, postoperative measures of strength, range of motion, and complications are comparable between groups, which persists when analyzing the timing and number of injections. These results support the use of subacromial corticosteroid injections as an effective conservative treatment prior to rotator cuff repair. However, there is still a lack of consensus on how close in proximity to surgery it is safe to receive an injection and what preoperative patient characteristics may be more likely to benefit from injection prior to surgery. Future studies are needed to assess the short-term impact of corticosteroid injections on outcomes of rotator cuff repair, particularly in athletes.

Partial infraspinatus tear with bursitis following an mRNA vaccination: a case report.

A 52-year-old Thai female without preexisting shoulder pathology and symptom had developed left shoulder pain for 3 days. Two weeks prior to shoulder pain, she received an mRNA COVID-19 vaccination. She positioned her arm in combined internal rotation with 60° of arm abduction. Her symptoms were pain in all directions of shoulder motion and tenderness at the bicipital groove and over the deltoid area. The testing of the rotator cuff power of the infraspinatus tendon showed pain. An MRI showed infraspinatus tendinosis with a low-grade (almost 50%) bursal-surface tear at the footprint of the superior fiber with associated overlying subacromial-subdeltoid bursitis. She was treated with both intraarticular and subacromial corticosteroid injections (triamcinolone acetate (40mg/ml) 1ml+1% lidocaine with adrenaline 9ml). She did not respond to oral naproxen but responded well to intraarticular and subacromial corticosteroid injections. The best way to deal with SIRVA is to prevent this condition by using the correct injection technique. First, the injection site should be two or three fingerbreadths below the mid-acromion process. Second, the needle's direction should be perpendicular to the skin. Third, using the correct needle penetration depth.

Efficacy of high-volume vs very low volume corticosteroid subacromial injection in subacromial impingement syndrome: a randomized controlled trial

Subacromial corticosteroid injections (SCI) treat shoulder pain from subacromial impingement syndrome (SIS). However, a high-volume corticosteroid injection (HVCI) increases the incidence of local and general complications from lidocaine. This study aimed to compare the results of functional and clinical outcomes between the very low-volume corticosteroid injection (VLVCI) and HVCI including to WORC (Western Ontario Rotator Cuff Index), VAS (Visual Analog Scale), DASH (The disabilities of the arm, shoulder, and hand) and ROM (Range of Motion). A total of 64 patients presenting with SIS were evaluated in two SCI volume in a randomization-controlled trial study. The VAS for pain pre-injection and post-injection at 15 min, was from 5.34 ± 2.44 at before injection to 2.44 ± 1.58 at post injection 15 min in the HVCI group (P < 0.001) and from 5.19 ± 2.33 to 2.84 ± 1.49 in VLVCI group (P < 0.001). Not significant differences at mean difference VAS post-injection 15 min VAS (P = 0.324) and Percentage difference VAS pre-injection and post-injection (P = 0.24). All follow-up timing, there were no significant differences in WORC, DASH and ROM between two groups (P > 0.05). The results revealed the VLVCI is non-inferior to HVCI both of functional outcomes and VAS.

Comparison of ultrasound-guided subacromial corticosteroid and ozone (O2-O3) injections in the treatment of chronic rotator cuff tendinopathy: a randomized clinical trial.

: The authors aimed to compare the effects of a one-time ultrasound (US)-guided subacromial corticosteroid injection and three-time ozone (O2-O3) injection in patients with chronic supraspinatus tendinopathy. : Participants were randomly assigned to the corticosteroid group (n = 22) or ozone group (n = 22). Injections in both groups were administered into subacromial bursa with an US-guided in-plane posterolateral approach. Primary outcome measure was the change in the Western Ontario Rotator Cuff Index (WORC) score between baseline and 12-weeks post-injection. Secondary outcome measures included visual analog scale and Shoulder Pain and Disability Index scores. Assessments were recorded at baseline, and 4-weeks and 12-weeks post-injection. : Forty participants completed this study. Based on repeated measurement analysis of variance, a significant effect of time was found for all outcome measures in both groups. Both the groups showed clinically significant improvements in shoulder pain, quality of life, and function. Baseline, 4-week post-injection, and 12-week post-injection WORC scores (mean ± standard deviation) were 57.91 ± 18.97, 39.10 ± 20.50 and 37.22 ± 27.31 in the corticosteroid group, respectively and 69.03 ± 15.89, 39.11 ± 24.36, and 32.26 ± 24.58 in the ozone group, respectively. However, no significant group × time interaction was identified regarding all outcome measures. : Three-time ozone injection was not superior to a one-time corticosteroid injection in patients with chronic supraspinatus tendinopathy. It might be as effective as corticosteroid injection at 4-weeks and 12-weeks post-injection in terms of relieving pain and improving quality of life and function.

Fact or fiction: the "5mm Rule" in greater tuberosity fractures of the proximal humerus.

The purposes of this study were 1) to assess the outcome of nonoperative management of GT fractures with > 5mm of displacement and 2) to assess whether there is a correlation between degree of displacement and outcome. This study was a retrospective review of consecutive low-energy GT fractures from 2011 to 2020. Radiographs from all visits were reviewed. The direction of maximal displacement was assessed. Subjects were stratified based on the amount of maximal displacement: Group 1: 0-5mm, Group 2: 5-10mm, Group 3: > 10mm. Range of motion (ROM) at the time of final follow-up was assessed. The presence of persistent shoulder pain after healing was noted, as well as whether supplemental subacromial corticosteroid injection was provided as part of long-term treatment. A cohort of 93 fractures comprised the study group. Mean age was 62years. Mean follow-up was 20months. All fractures went on to union. Mean displacement was 6.2mm. There were 43 patients in Group 1, 43 in Group 2, and 7 in Group 3. Maximal displacement was most commonly inferolateral or lateral, accounting for a combined 77% of all patients. There was no difference in final ROM between displacement groups, with at least 155 degrees of forward elevation and 45 degrees of ER in all three groups. There was no difference between Group 1 and Groups 2/3 in frequency of persistent pain or likelihood of receiving a steroid injection. Our findings do not support a discrete 5mm displacement threshold for surgical repair of isolated greater tuberosity fractures.

Nonsteroidal Anti-inflammatory and Corticosteroid Injections for Shoulder Impingement Syndrome: A Systematic Review and Meta-analysis.

To determine optimal treatment strategies for shoulder impingement syndrome (SIS). To compare subacromial nonsteroidal anti-inflammatory injections (SNIs) and subacromial corticosteroid injections (SCIs) on pain relief and functional improvement in individuals with SIS. Second, to perform a cost analysis of the 2 injections. MEDLINE, SPORTDiscus, CINAHL, Embase, Web of Science, and SCOPUS databases were searched for randomized controlled trials using several keywords. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized, and 10 studies comparing changes in pain or function in humans with SIS receiving SNIs or SCIs were included. Quality and risk of bias were assessed using the Consolidated Standards of Reporting Trials (CONSORT) 2010 scale and the Cochrane Collaboration tool. Systematic review and meta-analysis. Level 1. Baseline and follow-up scores of the visual analog, Constant-Murley, and University of California Los Angeles shoulder scales were extracted to calculate effect sizes (ESs), represented as Cohen d. Metaregression and publication bias analyses were performed. Procedural and medication costs were extracted from Medicare guidelines. A total of 7 high and 3 good quality studies were included, with a mean score of 21.1. Only 1 study had a high risk of bias. The meta-analyses produced pooled ESs of 0.05 (P = 0.83), 0.12 (P = 0.71), and 0.07 (P = 0.79) for each scale, respectively, with CIs crossing 0. Procedural costs were equal between groups, whereas ketorolac was the least costly medication ($0.47). There was no significant difference in side effects between the 2 injections. SNIs are as effective as SCIs for short-term pain relief and improving function in patients with subacromial impingement syndrome. In addition, they are less expensive and cause no major difference in complications, providing a viable, cost-effective alternative for injection therapy in patients with SIS.

Ultrasound-Guided Subacromial Corticosteroid Injections in Comparison to Anatomic Landmark-Guided Injections in Subacromial Impingement Syndrome

Ultrasound-Guided Subacromial Corticosteroid Injections in Comparison to Anatomic Landmark-Guided Injections in Subacromial Impingement Syndrome

Comparison of the efficacy of physiotherapy, subacromial corticosteroid, and subacromial hyaluronic acid injection in the treatment of subacromial impingement syndrome: A retrospective study

Background: The optimal nonoperative management for subacromial impingement syndrome (SIS) is unclear. This study evaluated the efficacy of subacromial corticosteroid versus a hyaluronic acid injection and their effectiveness against physiotherapy in patients with SIS. Methods: SIS patients treated with either physiotherapy or subacromial injection of triamcinolone (40 mg), or subacromial hyaluronic acid injection were included in this retrospective study. The outcome measures were evaluated 3 and 6 mo after the intervention and included pain evaluated by a visual analog scale (VAS) and limb function assessed by the Disabilities of the Arm, Shoulder, and Hand (DASH) and American Shoulder and Elbow Surgeons (ASES) questionnaires. Results: Eighty-eight patients with SIS were included. Treatment was done with corticosteroid injection in 31 patients, hyaluronic acid injection in 30 patients, and physiotherapy in 27 patients. The mean improvement of VAS, DASH, and ASES scores of the corticosteroid group was significantly higher when compared with the physiotherapy group at 3 mo (P=0.035, P&lt;0.001, and P&lt;0.001, respectively) and 6 mo (P=0.036, P&lt;0.001, and P&lt;0.001, respectively), also in comparison with the hyaluronic acid group at 3 mo (P=0.038, P&lt;0.001, and P=0.002, respectively) and 6 mo (P=0.044, P&lt;0.001, P&lt;0.001, respectively). The mean improvement of DASH and ASES scores, but not VAS, was significantly higher in the hyaluronic acid group compared to the physiotherapy group at 3 mo (P=0.022, P=0.034, and P=0.55, respectively) and 6 mo (P=0.46, P=0.039, and P=0.51, respectively). Conclusion: Subacromial corticosteroid injection is more effective than physiotherapy and hyaluronic acid injection in treating SIS symptoms. Level of Evidence: Level III.

Ultrasound-Tailored Treatment of Subacromial Shoulder Pain

Background and Objectives: Subacromial shoulder pain is the most common cause of shoulder pain consultation in musculoskeletal practice. Partial supraspinatus tendon tears have frequently been treated using a subacromial corticosteroid injection or surgery. The clinical use of a platelet-rich plasma (PRP) injection is an alternative treatment method for the condition, despite the paucity of evidence of its efficacy. The objective of the study was to assess the clinical effectiveness of autologous PRP in comparison to steroid injection in terms of pain relief and functional restoration in subacromial shoulder pathology. Methodology: All the patients above 18 years of either sex presenting with complaints of shoulder pain and painful abduction and elevation of arm for more than 6 weeks and not received any steroid injection in the previous 6 months were included in the study. In intra-articular PRP (IA-PRP), i.e., test group, 20 patients received 3 ml of single IA PRP injection, and in the steroid group (control group), 20 patients received 1 ml of intra-articular corticosteroid (IA CS) into glenohumeral joint under ultrasound (US) guidance. All patients were prospectively followed for 6 months. Results: There were no differences in visual analog scale (VAS) and disability scores between the PRP and corticosteroid groups at 1-month follow-up. However, the PRP group had better scores than the corticosteroid group on both the VAS and disability scores at 3- and 6-month follow-up. The VAS and disability scores did not change significantly at 6-month follow-up in the corticosteroid group; however, the PRP group showed continued improvement in both VAS and disability scores between 1- and 6-month follow-up. The PRP group had better scores than the corticosteroid group on shoulder range of motion after postintervention follow-up after 1 month. There were no complications in either group. Conclusion: Both subacromial PRP and corticosteroid injections had a positive clinical response in the treatment of shoulder pain. In view of the reached results, it may be assumed that steroid injections may provide symptomatic relief but not promote healing which makes PRP injection a good alternative as it is simple, easy to use, easily available, prepared from patient's own blood, and cost-effective. US-guided injections may increase the efficacy of accurately targeted injections.

DOES ULTRASONOGRAPHY GUIDED STEROID INJECTIONS PROVIDE BETTER OUTCOME IN SHOULDER IMPINGEMENT SYNDROME? A PROSPECTIVE STUDY

Shoulder pain is the third most common musculoskeletal complaint in orthopedic practice and impingement syndrome is one of the more common underlying diagnosis(1). Neers classification system is used as a criteria for diagnosis. The affected patients are generally over age 40(1). Patients present with pain on elevating the arm or when lying on the affected side. Individuals will often present with complaints of pain upon lifting the arm or with lying on the affected side. They may report loss of motion as the primary reason they come in to be evaluated, or that nighttime pain prevents them from sleeping. Weakness and stiffness often result secondary to the pain(1,2). The decision to treat conservatively or surgically is generally made on the basis of the duration and severity of pain, the degree of functional disturbance, and the extent of structural damage. The goal of treatment is to restore pain-free and powerful movement of the shoulder joint.(1) There is a wide variety of conservative treatments for SIS ranging from different physiotherapy modalities such as joint mobilisation techniques and strengthening exercises, adaptations of daily activities, non-steroidal anti-inflammatory drugs (NSAIDs) as well as steroid injections(4). Subacromial corticosteroid injection (CSI) is a popular SIS treatment method amongst orthopaedists, rheumatologists and general practitioners(5). This method is regarded as an inexpensive and effective way to both diagnose and treat symptomatic rotator cuff disease and SIS (6). Therapeutic effects of CSI on pain, inflammation and range of motion (ROM) have mostly been observed as being limited to a short-term effect (7). It is important to increase the accuracy rate of the steroid injection to get a better clinical outcome in relieving pain and improving function. This study intends to find out the superiority of USG guided subacromial steroid injection over landmark guided subacromial steroid injection in shoulder impingement syndrome. Objective of the study- To compare the difference between Ultrasound guided and landmark guided steroid injection , with the hypothesis that ultrasound guided injection technique has superior outcome. Methods It is an observational clinical study, carried out at a Tertiary Hospital MGM Medical college at Navi Mumbai between July 2021 and December 2021 for 6 months duration, which included 100 patients showing signs and symptoms of shoulder impingement syndrome. Patient were categorized into ultrasound guided subacromial steroid injection group and landmark guided subacromial steroid injection group. Written and informed consent was taken from each patient willing to be enrolled in the study. A 2 weekly, 4 weekly and 6 weekly follow up post treatment was done on an OPD basis . During each visit patients evaluation was done using SPADI (shoulder pain and disability index) score. Conclusion Improvement of shoulder function and pain was statistically significant in Ultrasound guided subacromial steroid injection as compared to landmark guided subacromial steroid injection. Therefore functional outcome of ultrasound guided subacromial steroid injection is better than landmark guided subacromial steroid injection.

Glucopuncture for Rotator Cuff Related Shoulder Pain: an Alternative for Cortisone?

As rotator cuff related shoulder pain is quite prevalent, it is important that doctors continue to look for new treatment modalities, which are safe and effective. Over the last decade, isotonic glucose (or dextrose) injections have received more attention among clinicians. Unfortunately, no large randomized clinical trials have confirmed their effectiveness so far. However, their safety profile is very likely to be much better than subacromial corticosteroid injections. This article invites the medical community for further basic-science and clinical studies to investigate the potential benefits of local isotonic glucose injections for rotator cuff related shoulder pain. The goal of introducing the term Glucopuncture is to explain the difference with prolotherapy, to inform doctors about the interesting riskbenefits ratio of these regional isotonic glucose injections and to invite them to use these sugar water injections instead of cortisone injections.

Ultrasound-guided versus landmark-guided subacromial corticosteroid injections for rotator cuff related shoulder pain: A systematic review of randomised controlled trials.

Rotator cuff related shoulder pain (RCRSP) is the most common presentation of shoulder pain within physiotherapy. Corticosteroid injections (CSI) have become increasingly popular to reduce pain, increase range of motion (ROM) and improve shoulder function. Evidence around the use of ultrasound-guided (USG) versus landmark-guided (LMG) CSIs remains controversial. The objective of this appraisal was to compare the effectiveness of each approach in the management of RCRSP. Cochrane, PubMed and CINAHL electronic databases were searched (from January 2014 to February 2021). Randomised controlled trials (RCTs) were included comparing USG to LMG CSIs for RCRSP. An independent reviewer selected the studies, extracted and synthesised the data. Two reviewers carried out a quality appraisal. Outcome measures were pain, function and ROM. Four RCTs (n=179 participants, n=184 shoulders) were reviewed. Both USG and LMG groups showed statistically significant within group improvements in clinical outcomes. There were no significant differences between groups. Three studies were identified as being a 'low' risk of bias (RoB) and did not favour the use of ultrasound. One study did favour the use of ultrasound for improving function, although it was found to have 'high' RoB. Adverse events were seldom reported. There is limited evidence to suggest using USG CSIs has a superior effect on clinical outcomes compared to LMG, though small sample sizes and lack of long-term follow-up limit the generalisability of the findings.