Background Meta-analyses on management of shoulder pain suggest that corticoids perijoint injection or its intramuscular administration has equivalent results in terms of relieve of symptoms. However, most of those meta-analyses include studies which do not distinguish among the different kinds of tendonitis, presence or absence of calcifications and if the puncture was or was not guided by ultrasonography.
Objectives The aim of this study is to compare the effect of intramuscular corticoids administrations and perijoint injection in patients diagnosed by superspinatus tendinosis.
Methods Observational study based on common clinical practice (protocols of shoulder pain follow-up of the Unit of rheumatologic and musculoskeletal urgencies). We included patients who were assessed due to shoulder pain in our A&E department with diagnosis of superspinatus tendinosis with or without calcifications. All patients fulfilled a follow-up card with data related to their pain level (Visual analogic scale from 0 to 10) and were assessed again three weeks after. In this second visit data were collected. Main variable was the pain level at 7th and 21st days. Corticoid used was triamcinolone (40mg). Shoulder injections included also 2ml of 2% Mepivacaine.
Results 35 patients with calcifications and 54 patients without calcifications were included. 31/54 Patients without calcifications underwent a conventional shoulder injection by posterior access, rest of them received an intramuscular dose. In patients with calcifications, 15/35 underwent a conventional shoulder injection by posterior access, 11/35 by lateral access guided by ultrasonography and 9/35 received intramuscular treatment.
Pain level change did not show statistical differences in patients with calcifications regardless the way of corticoids administration. In patients with calcifications the change in pain level was significant higher in patients who underwent a guided shoulder injection than the conventional puncture and the intramuscular administration at the first week (3.1, 5.3 and 5.4 respectively; P<0.0001) and 21st day (2.2, 5.8 and 6.0 respectively; P<0.0001). Figure 1 details our findings.
Conclusions Our results are aligned with previous studies demonstrating that intramuscular or perijoint injection of corticoids are equally efficient in pain control, however, benefit of ultrasonographic guidance in patients with a superspinatus calcification is clinically relevant and measurable since the first week. We recommend performing ultrasonographic-guided corticoids injections in patients with superespinatus calcifications.
Disclosure of Interest None declared