Background Musculoskeletal conditions have an enormous impact worldwide reaching up to 17-18% of all main complains in an emergency department (ED). About 7% of all those complains are related to shoulder non-traumatic issues and most of them due to rotator cuff pathology which is also the most prevalent cause of re-visits to ED within a month in our local experience. The corticosteroid injection has been widely used to solve acute rotator cuff tendinitis or bursitis. Many studies have compared the ultrasound guided injection (UGI) versus the blind (physical examination-guided) injection (BI) of corticosteroids and their results are not conclusive. No studies have been conducted to analyze the save of sanitary resources.
Objectives To evaluate the effectiveness of both techniques in terms of reduction of new ED visits and further need of specialized or primary care follow up.
Methods A retrospective observational study was performed including patients over 16 years old, who visit our ED for the first time due to a shoulder periarthritis between 2008 and 2011. All of them had to have been formerly diagnosed by means of an ultrasound study and naive to steroids local injection. Cases were classified according to the US diagnosis and the type of procedure performed. For statistical analysis we used T-student or Chi-square test where appropriate.
Results One hundred and twenty eight ED medical files were analyzed (96 BI, 32 UGI). Age and sex of both groups were comparable. Supraspinatus and subscapularis tendinosis proportions were similar in both groups as also subacromial bursitis. UGI Patients presented again fewer times to ED after the procedure, required fewer subsequent injections and less further follow up, although this last difference was not statistically significant. (See table).
Conclusions Although the aim of this study was to observe the effect of two techniques in an homogenous group of cuff rotator pathology, several factors could have conditioned the decision between BI and UGI. Probably UGI was performed in complex cases (uncertain access, anticoagulated patients, and higher symptoms intensity). Even considering that fact, UGI reduced significantly the number of subsequent visits to the ED, the need for further steroids injections and showed a tendency to reduce the need of specialized follow up, thus we consider that UGI must be the technique of choice when its application is feasible.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.