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Subacromial injections with vs without ultrasound guidance had similar clinical outcomes
Subacromial injections without ultrasound guidance are cost and time saving for patients and clinicians.
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A comparison of subacromial injections performed with vs. without ultrasound guidance showed no significant differences in clinical outcomes for treatment of subacromial impingement syndrome of the shoulder, according to study results.
“The take-home [message] is you do not need ultrasound to perform subacromial injections of corticosteroid and local anesthetic for impingement syndrome,” George A.C. Murrell, MBBS, DPhil, MD, told Orthopedics Today.
Cost, time saving
Murrell and his colleagues randomly assigned 56 shoulders with subacromial impingement syndrome to receive a subacromial corticosteroid injection with ultrasound guidance (ultrasound group) or a subacromial corticosteroid injection without ultrasound guidance (blind group). Researchers obtained VAS for pain with overhead activities and the American Shoulder and Elbow Surgeons (ASES) score before the injection and at 6 weeks after the injection.
Results showed the ultrasound group experienced a decrease in VAS pain scores (100-mm scales with 100 being the worst pain, zero equal to no pain) with overhead activities from approximately 59 mm before the injection to 33 mm at 6 weeks after the injection, and the blind group experienced a decrease of approximately 63 mm before the injection to 39 mm at 6 weeks after the injection. Results also showed the ASES score increased from approximately 57 before the injection to 68 at 6 weeks after the injection in the ultrasound group and from approximately 54 before the injection to 65 at 6 weeks after the injection in the blind group. Researchers noted no significant difference in the decrease in the VAS score or increase in the ASES score (100-point scale) between groups. Overall, 14% of shoulders in the ultrasound group eventually needed surgery vs. 21% in the blind group, according to results.
“Health care providers who decide on [subacromial injection] treatment can give it in their office,” Murrell said. “They do not need to send them off for ultrasound intervention, and there is obviously cost saving here and is also time saving for the patient and the clinician.”
Complications
Despite the results, Murrell noted the findings are at odds with protocol in Australia where physicians cannot be reimbursed for injecting the subacromial space unless ultrasound is used. He also stated the possibility that an orthopedic surgeon who was not trained well may not inject the corticosteroid in the correct place.
“Having said this, there are other studies that say systemic corticosteroids are just as effective for this problem,” Murrell said.
He added future research should look into other ways to manage supraspinatus tendinopathy.
“We are still looking for ways to manage supraspinatus tendinopathy,” Murrell said. “Corticosteroids are relatively inexpensive and relatively safe, but we are hoping there might be some other ways of managing these problems.” – by Casey Tingle
- Reference:
- Cole BF, et al. Am J Sports Med. 2016;doi:10.1177/0363546515618653.
- For more information:
- George A.C. Murrell, MBBS, DPhil, MD, can be reached at the Orthopaedic Research Institute, St. George Hospital, 4-10 Short St., Kogarah NSW 2217, Sydney, Australia; email: murrell.g@ori.org.au.
Disclosure: Murrell reports no relevant financial disclosures.