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Ultrasound-guided Subacromial-Subdeltoid Bursa Steroid Injections: Retrospective Comparison of Two Approaches and the Assessment of Impingement Tests to Predict Efficacy

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Objective: Compare the efficacy of two approaches to ultrasound-guided subacromial-subdeltoid bursa injections and to assess whether shoulder impingement tests acts as a predictive factor for efficacy of the injection.

Design: Retrospective chart review and telephone survey of 40 Patients who received ultrasound-guided subacromial-subdeltoid injections using 4cc 1% lidocaine and 80mg methylprednisolone from January 2011 to December 2011.  Outcome measures included:  number of positive shoulder impingement tests (Neer, Hawkin, Yocum), pain level (10-Point VAS), and duration of pain relief (<4 weeks, 4-12 weeks, >12 weeks). 

Results: 19 patients received the injection through an anterior-superior approach, while 21 patients received the injection through a posterior approach.   Mean reduction of the VAS score with the anterior-superior approach was 3.42 (SD-2.36); the posterior approach was 4.71 (SD-2.70).  There was no significant difference in the mean reduction of the VAS score between the two groups (p=0.11).  Mean reduction of the VAS score after injection for patients with 1 positive impingement test was 2.57 (SD-3.04), 2 positive impingement tests was 4.47 (SD-2.50), and 3 positive impingement tests was 4.50 (SD-2.46).  Single-factor ANOVA analysis revealed a p-value of 0.22.  The number of impingement signs had a statistically significant effect on duration of pain relief (p=0.01).

Conclusion: There was no statistically significant difference in the efficacy measured by change in the VAS score or the duration of relief between the two ultrasound-guided approaches to the subacromial-subdeltoid injection. The number of positive impingement tests on physical examination had a significant effect on duration of pain relief from the injections.

23 Mar, 2015
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e-Published: 16 Oct, 2015


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