Subacromial Steroid Injection Research Articles

The impact of central sensitization-related symptoms on subacromial steroid injection outcomes in patients with subacromial impingement syndrome: an observational study.

Evidence indicates that central sensitization (CS) plays a role in subacromial impingement syndrome (SIS). Reduced treatment response has been associated with pretreatment pain sensitization features, such as CS-related symptoms. Patients who received subacromial steroid injection were evaluated before the injection, at the first and third months. CS-related symptoms were investigated through the central sensitization inventory (CSI), and pain hypersensitivity was investigated by pressure pain threshold (PPT). Patients were evaluated using the visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand, Hospital Anxiety and Depression Scale, and Short Form-36. With the injection, all participants had a significant reduction in shoulder pain (P < 0.05). In all follow-ups, VAS values did not differ significantly between the groups, and patients with CSI ≥ 40 had higher levels of disability, anxiety, depression, and worse quality of life before treatment (P < 0.05). Post-injection disability decreased significantly in the CS group and reached similar levels in both groups at the third month (P > 0.05). Although both groups' PPT values were comparable pre-treatment and at the third month, the CS group's affected shoulder showed a notable PPT decline at the first month (P < 0.05). Pre-treatment CS-related symptoms had no effect on SIS patients' responsiveness to steroid injections.

The SAInT study: a protocol for a randomized controlled trial of steroid injection for subacromial pain syndrome using the anterolateral versus posterior approach.

Steroid injections are used for subacromial pain syndrome and can be administered via the anterolateral or posterior approach to the subacromial space. It is not currently known which approach is superior in terms of improving clinical symptoms and function. This is the protocol for a randomized controlled trial (RCT) to compare the clinical effectiveness of a steroid injection given via the anterolateral or the posterior approach to the subacromial space. The Subacromial Approach Injection Trial (SAInT) study is a single-centre, parallel, two-arm RCT. Participants will be allocated on a 1:1 basis to a subacromial steroid injection via either the anterolateral or the posterior approach to the subacromial space. Participants in both trial arms will then receive physiotherapy as standard of care for subacromial pain syndrome. The primary analysis will compare the change in Oxford Shoulder Score (OSS) at three months after injection. Secondary outcomes include the change in OSS at six and 12 months, as well as the Pain Numeric Rating Scale (0 = no pain, 10 = worst pain), Disabilities of Arm, Shoulder and Hand questionnaire (DASH), and 36-Item Short-Form Health Survey (SF-36) (RAND) at three months, six months, and one year after injection. Assessment of pain experienced during the injection will also be determined. A minimum of 86 patients will be recruited to obtain an 80% power to detect a minimally important difference of six points on the OSS change between the groups at three months after injection. The results of this trial will demonstrate if there is a difference in shoulder pain and function after a subacromial space steroid injection between the anterolateral versus posterior approach in patients with subacromial pain syndrome. This will help to guide treatment for patients with subacromial pain syndrome.

Effectiveness of subacromial steroid injection and hydrodilatation in the treatment of adhesive capsulitis: A comparative analysis.

Objective: To compare the effectiveness of Subacromial Steroid Injection (SAI) and Hydrodilatation in treating adhesive capsulitis (frozen shoulder). Study Design: Observational study. Setting: Department of Orthopedic, Dr. Ziauddin Hospital, Located in North Nazimabad, Karachi, Pakistan. Period: March 2023 to September 2023. Methods: Included 138 participants with primary adhesive capsulitis. Participants were divided into two groups: one received hydrodilatation and the other received SAI. The Disability of Arm, Shoulder, and Hand (DASH) Score and Visual Analogue Scale (VAS) were used for pre and post-treatment assessments at intervals of 2 weeks, 6 weeks, and 6 months. SPSS version 23 was used to analyze the data. Results: Both groups show significant reductions in pain scores and DASH scores over time (p-value&lt;0.05 for changes within each group). There are significant differences in pain scores and DASH scores between the groups at 6 weeks, 12 weeks, and 6 months (p-value&lt;0.05), with the hydrodilatation group showing better outcomes. Moreover, the mean reduction in pain scores and DASH scores from pre-treatment to 6 months is significantly greater in the hydrodilatation group compared to the SAI group (p-value&lt;0.05). Conclusion: While both Hydrodilatation and SAI are effective in reducing pain and improving functionality in patients with adhesive capsulitis, Hydrodilatation appears to be more effective in achieving these outcomes, particularly in terms of pain management and functional improvement.

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.

Efficacy of ultrasound-guided subacromial bursa steroid injection for treating shoulder pain in post-stroke hemiparetic patients

Purpose: To assess the efficacy of ultrasound-guided subacromial bursa (SAB) steroid injection for treating hemiplegic shoulder pain (HSP) after stroke (CS), as well as its impact on joint mobility, and inflammatory mediators.Methods: Seventy-two (72) patients with CS-related HSP were divided into two groups: study and control groups. The study group received ultrasound-guided SAB injection of triamcinolone acetonide in addition to conventional treatment, while control group received only conventional rehabilitation. Both groups received 4 weeks of treatment and were assessed using pain visual analogue scale (VAS) and passive range of motion (PROM) indices before treatment and at 1, 4, and 12 weeks after treatment. Additionally, the Fugl-Meyer motor function (FMA-U) scale score, activities of daily living (ADL) score, modified Barthel index (MBI), serum IL-1β, IL-6, nitric oxide (NO) levels, and incidence of adverse reactions were assessed before and after 4 weeks of treatment.Results: The study group had a significantly higher total efficacy/effectiveness (86.11 %) compared to control group (53.89 %). Both groups showed initial decreases and subsequent increases in VAS and PROM from week 1 to week 12 after treatment. However, the study group had significantly lower VAS scores, angle of forward flexion, abduction, and external rotation at all time points compared to control group (p &lt; 0.05). At week 4, the study group had significantly higher FMA-U, ADL, and MBI scores, as well as significantly lower IL-1β, IL-6, and NO levels when compared to control group (p &lt; 0.05).Conclusion: Ultrasound-guided SAB steroid injection improves the efficacy of HSP after CS, improves joint mobility, and reduces serum levels of IL-1β, IL-6, and NO. Further large-sample studies with increased sample sizes and longer investigation periods are needed to validate these findings.

Glenohumeral versus subacromial steroid injections for impingement syndrome with mild stiffness: a randomized controlled trial.

The subacromial (SA) space is a commonly used injection site for treatment of impingement syndrome. For shoulder stiffness, glenohumeral (GH) injections are commonly performed. However, in cases of impingement syndrome with mild shoulder stiffness, the optimal site of steroid injection has yet to be identified. This prospective, randomized study compared the short-term outcomes of ultrasound-guided GH and SA steroid injections in patients who were diagnosed with impingement syndrome and mild stiffness. Each group comprised 24 patients who received either a GH or SA injection of 40 mg of triamcinolone. Range of motion and clinical scores were assessed before and 3, 7, and 13 weeks after the injection. GH and SA injections significantly improved the range of motion and clinical scores after 13 weeks of follow-up. Notably, targeting the GH joint resulted in an earlier gain of forward elevation, external rotation, and internal rotation in 3 weeks (P<0.001, P=0.012, and P=0.002, respectively) and of internal rotation and a Constant-Murley score in 7 weeks (P<0.001 and P=0.046). Subsequent measurements were similar between the groups and showed a steady improvement in all ranges of motion and clinical scores. GH injections may be more favorable than SA injections for treatment of impingement syndrome with mild stiffness, especially in improving the range of motion in the early period. However, the procedures showed similar outcomes after 3 months. Level of evidence: I.

Comparison Clinical Effects of Hypertonic Dextrose and Steroid Injections on Chronic Subacromial Bursitis: A Double-Blind Randomized Controlled Trial.

To determine and compare the treatment efficacy of subacromial steroid injections and dextrose prolotherapy (DPT) for chronic subacromial bursitis patients. 54 patients with chronic subacromial bursitis were enrolled in this double-blind randomized controlled trial. Shoulder pain and disability index (SPADI) and visual analog scale (VAS) were the primary outcomes. The steroid group (n = 26) exhibited significant VAS score improvements comparing to baseline at weeks 2, 6, and 12; the DPT group (n = 28) exhibited VAS score improvements at weeks 6, and 12. The steroid group displayed significant SPADI score improvements compared to baseline at weeks 2, 6, and 12, the DPT group exhibited significant score decreases at weeks 2, and 6. Compared with the DPT group, the steroid group demonstrated significantly greater decreases in VAS scores at weeks 2, and 6; the steroid group showed significantly greater decreases in SPADI scores at weeks 2, 6, and 12. Both hypertonic DPT and steroid injections can provide short-term improvements of pain and disability among chronic subacromial bursitis patients. Moreover, steroid injections showed better effectiveness than hypertonic DPT in ameliorating pain and improving function.

Effects of Platelet-Rich Plasma in Tear Size Reduction in Partial-Thickness Tear of the Supraspinatus Tendon Compared to Corticosteroids Injection

ObjectivesCorticosteroid (CS) injection is commonly used in partial-thickness rotator cuff tears to decrease pain. However, this could result in unwanted side effects, such as tendon rupture. Alternatively, platelet-rich plasma (PRP) injection is frequently used to treat tendinopathies because it enhances healing. This study aimed to compare the differences in tear size and functional scores between intralesional PRP and subacromial CS injections.MethodsPatients with symptomatic partial-thickness tears of the supraspinatus tendon who underwent conservative treatment for ≥ 3 months were enrolled. All patients underwent magnetic resonance imaging (MRI) to confirm the diagnosis. Fourteen and 15 patients were randomized to receive intralesional PRP and subacromial CS injections, respectively. Tears were measured in the coronal and sagittal planes. The patients underwent another MRI 6 months after the injection. Tear size was compared between the two MRI results. The American Shoulder and Elbow Surgeons Shoulder score (ASES) and Constant–Murley score (CMS) were also obtained.ResultsThe baseline data were similar between the groups. In the coronal plane, PRP and CS showed tear size reductions of 3.39 mm (P = 0.003) and 1.10 mm (P = 0.18), respectively. In the sagittal plane, PRP and CS showed tear size reductions of 2.97 mm (P = 0.001) and 0.76 mm (P = 0.29), respectively. Functional scores improved 6 months after injection in both groups, but PRP showed better functional scores than CS (P = 0.002 for ASES, P = 0.02 for CS).ConclusionIntralesional PRP injection can reduce the tear size in partial-thickness tears of the supraspinatus tendon. Subacromial steroid injection did not significantly affect the tear size. While CS improved functional scores compared with baseline, PRP resulted in better improvement 6 months post-injection.Trial registration Thai Clinical Trials Registry, TCTR20210428004. Registered 28 April 2021-retrospectively registered, TCTR20210428004.

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.

Clinical and radiological outcomes of ultrasound-guided barbotage using a spinal needle and subacromial steroid injection for calcific tendinitis of the shoulder.

BackgroundUltrasound (US)-guided techniques reported for the treatment of calcific tendinitis have mostly demonstrated good results. This study investigates the effect of US-guided barbotage using a spinal needle in patients with calcific tendinitis of the shoulder.MethodsThirty-six patients with calcific tendinitis of the shoulder treated by US-guided barbotage with a spinal needle and subacromial steroid injection were included in the study. We evaluated clinical outcomes based on American Shoulder and Elbow Surgeons (ASES) score, Constant score, and visual analog scale (VAS) for pain score. Radiological outcomes were assessed by X-ray imaging at each visit.ResultsOur results showed that US-guided barbotage and subacromial steroid injection produced good clinical and radiological outcomes in patients with calcific tendinitis of the shoulder. Of the 36 patients, only one required surgical treatment, while the others showed improvement without any complications. Compared to values before the procedure, calcific deposit size and VAS, ASES, and Constant scores showed significant improvement 6 weeks after the procedure. No significant correlation was found between the initial calcific deposit size and clinical outcomes at each time point.ConclusionsIn patients with calcific tendinitis of the shoulder, US-guided barbotage using a spinal needle and subacromial steroid injection can yield satisfactory clinical and radiological results.

Effects of steroid injection during rehabilitation after arthroscopic rotator cuff repair.

BackgroundThis study aims to compare the clinical outcomes of steroid injections during the rehabilitation period after arthroscopic rotator cuff repair (ACRC).MethodsAmong patients who underwent ARCR, 117 patients who met the inclusion and exclusion criteria were enrolled. Pain and range of motion (ROM) recovery at the 3-, 6-, and 24-month follow-up visits and functional outcome at the 24-month follow-up were compared between 45 patients who received ultrasound-guided subacromial steroid injection at postoperative week 4 or 6 and 72 patients who did not. Functional outcome was assessed using the American Shoulder and Elbow Surgeons (ASES) score and Constant score. Healing of the repaired tendon and retear were observed at the 6-month follow-up via magnetic resonance imaging (MRI) or computed tomography (CT) arthrography.ResultsAt the 3-month follow-up, the steroid injection group showed lower visual analog scale scores than the control group (p<0.05) and showed faster recovery of forward flexion and internal rotation (p<0.05). From the 6-month follow-up, the two groups did not show differences in pain and ROM, and the ASES score and Constant score also did not significantly differ at the 24-month follow-up. The two groups did not differ in retear rate as determined by MRI or CT arthrography at the 6-month follow-up.ConclusionsThis study demonstrated that ultrasound-guided subacromial steroid injection at 4 or 6 weeks after ARCR leads to quick pain reduction and ROM recovery until 3 months after surgery. Therefore, subacromial steroid injection is speculated to be an effective and relatively safe method to assist rehabilitation.

Ultrasound-guided needle decompression and steroid injection for calcific tendinitis of the shoulder: risk factors for repeat procedures and outcome analysis.

Background Although ultrasound-guided needle decompression (US-GND) can treat calcific tendinitis of the shoulder effectively, repeat procedures might be required for unresolved symptoms. We evaluated the overall clinical outcomes of US-GND with subacromial steroid injection and the final results and factors predisposing toward repeat procedures.Methods Ninety-eight patients who underwent US-GND for calcific tendinitis of the supraspinatus/infraspinatus were analyzed between March 2017 and December 2018. The clinical outcomes (pain visual analog scale, functional visual analog scale [FVAS], and American Shoulder and Elbow Surgeons [ASES] score) and final subjective satisfaction were compared between groups A (single US-GND) and B (repeat US-GND). The factors predisposing toward repeated US-GNDs were analyzed.Results We found that 59.3% (58/98) of patient ASES scores were ≥80, and 73.5% of patients (72/98) were satisfied with the outcome. Group B (n=14) demonstrated a significantly higher rate of dominant-arm involvement compared to group A (78.6% vs. 48.8%, p=0.046). However, initial calcification size, shape, number, density, subscapularis involvement, lavage, and procedure time did not differ significantly between the groups. Group B showed poorer final FVAS (7 [interquartile range, 6–8] vs. 8 [interquartile range, 7–9], p=0.036) and subjective satisfaction compared to group A (satisfied: 5 [35.7%] vs. 67 [79.8%], p<0.001].Conclusions US-GND with subacromial steroid injection is a viable treatment option for calcific tendinitis of the shoulder. Dominant-arm involvement was the only independent factor for repeated US-GND. Final outcome of repeated US-GND for unimproved patients was promising; however, these outcomes were poor compared to those of the patients who improved after the first procedure.

Comparison of Subacromial Ketorolac Inj Vs Subacromial Steroid Inj in Shoulder Impingement Syndrome

Aim: To compare the outcome of subacromial ketorolac injection versus subacromial steroid injection in Shoulder Impingement Syndrome. Methodology: This randomized controlled trial was done at the Department of Orthopedics Unit II, Mayo Hospital, Lahore from 26th April 2018 to 25th October 2018. The sample size was 218patients 15 to 60 years of age with shoulder impingement syndrome, were included and patients with a fracture or rotator cuff tear who presented with weakness and muscle wasting, taking regular systemic NSAIDs or steroids, history ofgastrointestinal (GI) ulcers and bleeding disorderswereexcluded. Randomization was done by lottery method.Group A (ketorolac group) was given a single injection of 60 mg ketorolac mixed with 1 ml 2% lidocaine and Group B (steroid group) was given 40 mg methylprednisolone mixed with 1ml 2% lidocaine. All patients were followed up on 4th weeks. Results: Out of 218 patients, 117(53.67%) were males and 101(46.33%) were females with a male to female ratio of 1.2:1.The mean age of patients in group A was 39.09±9.90years and in group, B was 38.08±8.61years. The mean post-injection VAS score in group A was 2.80±0.94 and in a group, B was 4.20 ± 0.98 with a p-value of &lt;0.001. The mean post-injection constant score in group A was 31.59±6.86 and in group, B was 41.31±4.56 with a p-value of &lt;0.001. Conclusion: Sub-acromial ketorolac injection showeda better mean pain score and constant score than subacromial steroid injection in patients with shoulder impingement syndrome. Keywords: Shoulder Impingement Syndrome, subacromial ketorolac injection, subacromial steroid injection,

Efficacy of Arthroscopic Surgery in the Management of Adhesive Capsulitis: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

To determine which interventions optimize clinical outcomes in adhesive capsulitis by performing a network meta-analysis of randomized controlled trials. A systematic review was conducted of all clinical trials on adhesive capsulitis published since 2008. Patient cohorts were grouped into treatment categories; data collected included range of motion (ROM) and patient-reported outcome measures (PROMs). Interventions were compared across groups by means of arm-based Bayesian network meta-analysis in a random-effects model. Sixty-six studies comprising 4042 shoulders (57.6% female patients, age 54.8 ± 3.2 years [mean ± standard deviation]) were included. The most commonly studied interventions were physical therapy (PT) or shoulder injections. Network meta-analysis demonstrated that arthroscopic surgical capsular release was the most effective treatment in increasing ROM. This effect was apparent in forward flexion (effect difference [ED] versus placebo, 44°, 95% confidence interval [CI] 31° to 58°), abduction (ED 58°, 45° to 71°), internal rotation (ED 34°, 24° to 44°), and external rotation (ED 59°, 37° to 80°). Interventions most effective for pain relief included PT supplemented with either medical therapy (ED -4.50, -9.80 to 2.80) or ultrasound therapy (ED -5.10, -5.10 to -1.40). Interventions most effective for improvement of functional status included PT, manipulation under anesthesia (MUA), intra-articular or subacromial steroid injection, surgical capsular release, and supplementation of PT with alternative therapy. No one treatment emerged superior in regard to ROM, pain symptoms, and functional status. Surgery (after failure of conservative treatment) ranked highest across all ROM domains. Treatments that ranked highest for treatment of pain included PT supplemented with either medical therapy or ultrasound. Finally, treatments that ranked highest for improvements in functional status included MUA, PT with medical therapy, surgical intervention, PT with ultrasound, PT with injection, and injection alone. II, systematic review and network meta-analysis of level I and II studies.

Ultrasound-Guided Versus Anatomic Landmark-Guided Steroid Injection of the Subacromial Bursa in the Management of Subacromial Impingement: A Systematic Review of Randomised Control Studies.

This study is a systematic review of prospective randomised control studies comparing ultrasound-guided steroid injection of the subacromial space with anatomic landmark-guided injection in the treatment of subacromial impingement to determine if there is any difference in pain relief and functional outcome. Mesh terms and free-text words search of electronic databases, reference list of identified studies and grey literature was performed using the PICO format. All identified papers were sifted sequentially by title, abstract and review of full text articles. Four papers qualified and were included in the review and analysis. The total number of patients in the studies was 234 patients with 117 patients randomised to each of landmark-guided and ultrasound-guided injection groups. There was no statistically significant difference in VAS pain scores (P = 0.67), SDQ scores (P = 0.43), SPADI disability score (P = 0.17) and functional outcomes scores (P = 0.09) at 4 to 6weeks when USS-guided subacromial steroid injection was compared with landmark-guided injection. SPADI pain scores (P = 0.02) demonstrates significant reduction in favour of landmark-guided injection. There was low to moderate risk of bias. In conclusion, ultrasound-guided subacromial steroid injection does not offer any statistically significant clinical improvement over landmark-guided injection in adults with subacromial impingement.

Ultrasound-guided versus blind subacromial corticosteroid and local anesthetic injection in the treatment of subacromial impingement syndrome: A randomized study of efficacy.

Objectives This study aims to compare the effects of ultrasound (US)-guided and blind subacromial corticosteroid and local anesthetic (LA) injection in the treatment of subacromial impingement syndrome (SIS) on shoulder pain, range of motion (ROM), and functionality.Patients and methods The prospective study was conducted between 01 February 2017 and 31 May 2017. A total of 29 patients with clinical findings and magnetic resonance imaging (MRI) consistent with SIS were randomized into two groups: 14 patients received US-guided subacromial corticosteroid and LA injection and 15 patients received a blind subacromial corticosteroid and LA injection. Patients were evaluated before and one month after treatment. One patient was lost to follow up. The primary outcome measure was a visual analog scale (VAS) for shoulder pain. Secondary outcomes were active shoulder ROM in flexion and abduction, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the modified Constant-Murley Score (CMS).Results Twenty eight patients (11 males, 17 females; mean age 39.5 in the US guided group and 42.5 in the blind group; range 20 to 64 years in both groups) completed the study. There was a significant improvement in VAS for shoulder pain, active ROM, DASH questionnaire score and modified CMS in both groups four weeks after treatment (p<0.05). There was no between-group difference in VAS, ROM or DASH questionnaire scores. Following treatment, the modified CMS in the US-guided injection group was higher than in the blind injection group (p=0.02). However, when the mean change in modified CMS in the US-guided injection group was compared to that of the blind injection group, the difference was insignificant (p=0.23).ConclusionBoth US-guided and blind subacromial steroid injection improve shoulder pain, ROM, and functionality in SIS; one treatment option was not found to be superior to the other. Therefore, blind injection can be performed in clinical settings where US is not available. Equally, blind injection can also be performed in patients who have a definite diagnosis of SIS based on clinical and MRI findings.

Proximal Approach of Ultrasound-guided Suprascapular Nerve Block: Comparison with Subacromial Steroid Injection.

BackgroundThis study was undertaken to evaluate early clinical outcomes of ultrasound-guided suprascapular nerve block (SSNB) using a proximal approach, as compared with subacromial steroid injection (SA).MethodsThis retrospective study included a consecutive series of 40 patients of SSNB and 20 patients receiving SA, from August 2017 to August 2018. The visual analogue scale (VAS), American Shoulder Elbow Surgeon’s score (ASES), University of California, Los Angeles score (UCLA), the 36 health survey questionnaire mental component summary (SF36-MCS), physical component summary (PCS), and range of motion (forward elevation, external rotation, and internal rotation) were assessed for clinical evaluations.ResultsCompared with the baseline, VAS, and ranges of motion in the SSNB group significantly improved at the 4-week follow-up (VAS scores improved from 6.7 ± 1.6 to 4.3 ± 2.4, p<0.001; all ranges of motion p<0.05), while other variables showed no statistically significant differences. All clinical variables were significantly improved in the SA group (p<0.05). However, all clinical scores at the 4-week follow-up showed no significant difference between groups.ConclusionsUltrasound-guided SSNB using proximal approach provides significant pain relief at 4-weeks after treatment, with statistically significant difference when compared with SA, suggesting that SSNB using proximal approach is a potentially useful option in managing shoulder pain. However, in the current study, it was less effective in improving shoulder function and health-related quality of life, compared with SA.

Shockwave therapy versus local steroid injection in chronic supraspinatus tendinopathy

ObjectiveTo evaluate the efficacy of shockwave therapy versus ultrasound-guided steroid injection in the treatment of chronic supraspinatus tendinopathy.Patients and methodsThis study was carried out on 30 patients with calcific and noncalcific supraspinatus tendinopathy for more than 3 months. A clinical assessment was performed for all patients including pain scoring by the visual analog scale and full shoulder examination at the start of the study and 6 weeks later. Shoulder ultrasound was performed at the start of the study. Fifteen patients received four sessions of radial shockwave therapy (Intelect Radial Shockwave, UK) 3 bar pressure, 2000 pulses, 20Hz. Fifteen patients received a single ultrasound-guided subacromial steroid injection (1ml triamcinolone 40mg and 1ml lidocaine).ResultsBoth groups showed a statistically significant improvement in pain relief (visual analog scale) and clinical examination: tenderness, shoulder range of motion, and muscle power. There was no statistically significant difference between both groups.ConclusionRadial shockwave therapy has no additional benefit over ultrasound-guided steroid injection in the short term in patients with chronic supraspinatus tendinopathy.

Comparison of functional outcome of ultrasound guided glenohumeral and subacromial methylprednisolone acetate injections in frozen shoulder

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Frozen shoulder also known as adhesive capsulitis is a common cause for limitation of motion and pain of the shoulder joint with an incidence of 2-5% in the general population. The aim of the study was to assess the functional outcome of ultrasound guided glenohumeral and subacromial methylprednisolone acetate steroid injection in patients with frozen shoulder.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 120 patients with frozen shoulder were randomly divided into 2 groups according to site i.e. glenohumeral and subacromial. Ultrasound-guided methylprednisolone acetate (80 mg) injection was administered. At follow up pain was being measured using VAS scale and functional outcome was measured using the DASH score and Constant score at day 0, 1 followed by 1, 3, 6 weeks and at 3 months.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The VAS score of glenohumeral decreased from 6.5±0.95 to 2.25±0.86 at 3 months and in subacromial it decreased from 6.37±1.07 to 2.3±0.72. DASH score in glenohumeral group decreased from 66.95±9.9 to 27.45±9.31 at 3 months and in the subacromial group it decreased from 67.52±10.65 to 26.81±11.14 at 3 months. In glenohumeral group Constant score increased from 46.63±7.18 to 72.66±7.38 at 3 months and in the subacromial group it increased from 47.92±6.91 to 70.28±6.97 at 3 months.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Spontaneous recovery does not necessarily occur even after a long period, so we recommend that these modalities should be offered to all patients with frozen shoulder and it would be of more value if carried out at an early stage of the disorder.&lt;/p&gt;

Increasing Numbers of Pre-operative Shoulder Injections are Associated with a Higher Rate of Subsequent Revision Rotator Cuff Surgery

Objectives:Subacromial steroid injections are frequently used in the initial conservative management of rotator cuff (RC) tears, however, the long-term effect of this treatment in patients who eventually undergo rotator cuff repair (RCR) is not well defined in the literature. The objective of this study is to identify any dose-dependent association between injections prior to rotator cuff repair (RCR) and subsequent revision surgery.Methods:Two large databases were queried for patients undergoing arthroscopic RCR. Patients with one year of pre-operative database exposure and a minimum of two years post-operative follow-up were included. In each database, three study groups were formed, stratified by the number of ipsilateral injections given within the year prior to RCR: one, two and three or more injections. A control group without any prior injection was identified and matched to the single injection group in each database. The outcome of interest was ipsilateral revision arthroscopic or open rotator cuff repair, or arthroscopic debridement for a diagnosis of rotator cuff tear within 2 years of the index surgery. Revision surgery rates were compared between groups using a multivariate logistic regression analysis controlling for demographic and comorbidity confounders. This allowed for identification of the independent association between the number of injections and the need for subsequent revision surgery.Results:108,516 patients from the Medicare database and 11,360 patients from the private database were included (Table 1A-B). There was no association between a single injection within the year prior to RCR and revision surgery in either database. In the Medicare database, two or more injections was associated with a substantial increase in the risk of requiring revision surgery (OR 2.40-2.62, P < 0.0001). A similar association was noted in the private insurance database for patients with two or more injections (OR 2.09-2.42, P < 0.0001) (Table 1A-B).Conclusion:A single shoulder injection within a year prior to arthroscopic RCR is not associated with any increased risk of revision surgery. Two or more injections within a year prior to RCR appears to be associated with a substantially increased risk of revision surgery. While causality cannot be established on the basis of this database review, caution is recommended when considering more than one shoulder injection in patients with potentially repairable RC tears.Table 1A.Risk of Revision Rotator Cuff Surgery Stratified by Number of Preoperative Injections (Medicare Patients)Ipsilateral Revision Surgery Study Group Total N N of Revisions % Revisions Adjusted O.R. [95% Cl] P Value Control103,5143,6913.6%--1 Injection2,7381033.8%1.09[0.96 - 1.25]0.1942 Injections1,137968.4%2.40 [2.08 - 2.76]< 0.00013+ Injections1,127998.8%2.62 [2.29 - 3.01]< 0.0001Table 1B.Risk of Revision Rotator Cuff Surgery Stratified by Number of Preoperative Injections (Humana Patients)Ipsilateral Revision Surgery Study Group Total N N of Revisions % Revisions Adjusted O.R. [95% Cl] P Value Control7,4622152.9%--1 Injection2,25067 3.0%0.95 [0.78 - 1.16]0.3332 Injections890536.0%2.09[1.69 - 2.58]< 0.00013+ Injections758577.5%2.42 [1.96 - 2.99]< 0.0001