Original article
The accuracy of subacromial corticosteroid injections: A comparison of multiple methods

https://doi.org/10.1016/j.jse.2007.07.010Get rights and content

Corticosteroids are commonly used in the treatment of the impingement syndrome. Efficacy, as well as accurate placement, have been questioned. The purpose of this prospective, randomized study is to assess the accuracy of subacromial injections and to correlate accuracy with short term clinical outcome at 3 months. Sixty shoulders, which were diagnosed with impingement syndrome, were randomized to receive a subacromial injection of corticosteroids, local anesthetic, and contrast dye from 1 of 3 locations: anterolateral, lateral, or posterior. Accuracy was confirmed by 3 radiographic views of the shoulder, while clinical ratings were assessed by the UCLA shoulder score and a 10-point visual pain analog scale during the initial, post-injection, and 3-month visits. The overall accuracy was 70%, with no difference among the 3 portals. Accuracy was not related to body mass index. Furthermore, accurate injections did not significantly improve the UCLA score, pain scale, or patient satisfaction at 3 months. In contrast, accurate injections produced a positive Neer's impingement test more often (35/39 vs 9/16; P = .009). Overall, there was an improvement in the UCLA score (26.2-32.2; P < .001) and a decrease in the pain scale (7.2-3.43; P < .001) at 3-month follow-up. In conclusion, the accuracy of injection was 70%. Clinical improvement did not correlate with accuracy; however, accuracy did reliably produce a positive impingement test. This multimodal treatment plan did produce significant improvement in shoulder function and pain level in the short term.

Section snippets

Materials and methods

This study was approved by the Institutional Review Board. All patients who had a history and physical exam findings consistent with the diagnosis of impingement syndrome, were recruited into the study. Inclusion criteria included: (1) a history of shoulder pain predominantly along the lateral aspect of the acromion near the insertion of the deltoid, especially with overhead activities; (2) symptoms that persisted for at least 2 months; (3) a positive impingement sign; (4) no major weakness of

Results

Sixty shoulders in 58 patients (age 30-85 years old, 28 males and 30 females) were enrolled in the study from July 2003 to April 2005. There was no difference among the 3 groups when stratified to gender, age, or BMI (Table I). Forty-two patients (42 shoulders) completed the 3-month follow-up examination in the office, while 16 (18 shoulders) completed the 3-month evaluation via telephone. Detailed telephone interviews to assess function, range of motion, and patient satisfaction were noted in

Discussion

Numerous meta-analyses have been published with mixed results regarding the efficacy of corticosteroid injections into the subacromial space for the impingement syndrome.4, 11, 12, 18, 25 Several prospective, randomized trials have been performed, specifically comparing corticosteroids against placebo. Blair et al6 compared corticosteroid with local anesthetic to local anesthetic alone and reported superior results in pain relief and shoulder range of motion with the addition of

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