Journal of Shoulder and Elbow Surgery
Volume 19, Issue 6 , Pages 795-801 , September 2010

Positive outcomes with intra-articular glenohumeral injections are independent of accuracy

  • Eric J. Hegedus, DPT, MHSc

      Affiliations

    • Physical Therapy Division, Department of Community and Family Medicine, Duke University School of Medicine, NC
    • Corresponding Author InformationReprint requests: Eric J. Hegedus, DPT, MHSc, Associate Professor and Medical Director, Doctor of Physical Therapy Division, Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC 27708.
  • ,
  • John Zavala, MD

      Affiliations

    • Steadman Hawkins Clinic of the Carolinas, Greenville Hospital System, Greenville, SC
  • ,
  • Michael Kissenberth, MD

      Affiliations

    • Greenville Hospital System, Greenville, SC
    • University of South Carolina School of Medicine, Columbia, SC
  • ,
  • Chad Cook, PT, PhD, MBA

      Affiliations

    • Physical Therapy Division, Department of Community and Family Medicine, Duke University School of Medicine, NC
  • ,
  • Kyle Cassas, MD

      Affiliations

    • Steadman Hawkins Clinic of the Carolinas, Greenville Hospital System, Greenville, SC
    • University of South Carolina School of Medicine, Columbia, SC
  • ,
  • Richard Hawkins, MD

      Affiliations

    • Steadman Hawkins Clinic of the Carolinas, Greenville Hospital System, Greenville, SC
    • University of South Carolina School of Medicine, Columbia, SC
    • University of Colorado, Boulder, CO
    • University of Texas Southwestern Medical Center, Dallas, TX
  • ,
  • Allison Tobola, MD

      Affiliations

    • Trinity Mother Frances/University of Texas Health Science Center, Tyler Primary Care Sports Medicine Fellowship Program, Tyler, TX

References 

  1. Adebajo AO, Nash P, Hazleman BL. A prospective double blind dummy placebo controlled study comparing triamcinolone hexacetonide injection with oral diclofenac 50 mg TDS in patients with rotator cuff tendinitis. J Rheumatol. 1990;17:1207–1210PMID:2290163
  2. Akgun K, Birtane M, Akarirmak U. Is local subacromial corticosteroid injection beneficial in subacromial impingement syndrome?. Clin Rheumatol. 2004;23:496–500
  3. Alvarez CM, Litchfield R, Jackowski D, Griffin S, Kirkley A. A prospective, double-blind, randomized clinical trial comparing subacromial injection of betamethasone and xylocaine to xylocaine alone in chronic rotator cuff tendinosis. Am J Sports Med. 2005;33:255–262
  4. Bartolozzi A, Andreychik D, Ahmad S. Determinants of outcome in the treatment of rotator cuff disease. Clin Orthop Relat Res. 1994;90–97PMID:7955708
  5. Berry H, Fernandes L, Bloom B, Clark RJ, Hamilton EB. Clinical study comparing acupuncture, physiotherapy, injection and oral anti-inflammatory therapy in shoulder-cuff lesions. Curr Med Res Opin. 1980;7:121–126
  6. Blair B, Rokito AS, Cuomo F, Jarolem K, Zuckerman JD. Efficacy of injections of corticosteroids for subacromial impingement syndrome. J Bone Joint Surg Am. 1996;78:1685–1689PMID:8934482
  7. Bulgen DY, Binder AI, Hazleman BL, Dutton J, Roberts S. Frozen shoulder: prospective clinical study with an evaluation of three treatment regimens. Ann Rheum Dis. 1984;43:353–360
  8. Carette S, Moffet H, Tardif J, Bessette L, Morin F, Fremont P, et al. Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial. Arthritis Rheum. 2003;48:829–838
  9. Chen MJ, Lew HL, Hsu TC, Tsai WC, Lin WC, Tang SF, et al. Ultrasound-guided shoulder injections in the treatment of subacromial bursitis. Am J Phys Med Rehabil. 2006;85:31–35
  10. Croft P, Pope D, Silman A. The clinical course of shoulder pain: prospective cohort study in primary care. Primary Care Rheumatology Society Shoulder Study Group. BMJ. 1996;313:601–602PMID:8806252
  11. Ekeberg OM, Bautz-Holter E, Tveita EK, Juel NG, Kvalheim S, Brox JI. Subacromial ultrasound guided or systemic steroid injection for rotator cuff disease: randomised double blind study. BMJ. 2009;338:a3112
  12. Eustace JA, Brophy DP, Gibney RP, Bresnihan B, FitzGerald O. Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms. Ann Rheum Dis. 1997;56:59–63
  13. Ginn KA, Cohen ML. Conservative treatment for shoulder pain: prognostic indicators of outcome. Arch Phys Med Rehabil. 2004;85:1231–1235
  14. Grafton KV, Foster NE, Wright CC. Test-retest reliability of the Short-Form McGill Pain Questionnaire: assessment of intraclass correlation coefficients and limits of agreement in patients with osteoarthritis. Clin J Pain. 2005;21:73–82
  15. Gruson KI, Ruchelsman DE, Zuckerman JD. Subacromial corticosteroid injections. J Shoulder Elbow Surg. 2008;17:118S–130S
  16. Henkus HE, Cobben LP, Coerkamp EG, Nelissen RG, van Arkel ER. The accuracy of subacromial injections: a prospective randomized magnetic resonance imaging study. Arthroscopy. 2006;22:277–282
  17. Hollingworth GR, Ellis RM, Hattersley TS. Comparison of injection techniques for shoulder pain: results of a double blind, randomised study. Br Med J (Clin Res Ed). 1983;287:1339–1341
  18. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602–6086<602::AID-AJIM4>3.0.CO;2-L
  19. Jacob AK, Sallay PI. Therapeutic efficacy of corticosteroid injections in the acromioclavicular joint. Biomed Sci Instrum. 1997;34:380–385PMID:9603070
  20. Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986;27:117–126
  21. Kang MN, Rizio L, Prybicien M, Middlemas DA, Blacksin MF. The accuracy of subacromial corticosteroid injections: a comparison of multiple methods. J Shoulder Elbow Surg. 2008;17:61S–66S
  22. Kuijpers T, van der Windt DA, van der Heijden GJ, Bouter LM. Systematic review of prognostic cohort studies on shoulder disorders. Pain. 2004;109:420–431
  23. Lopes RV, Furtado RN, Parmigiani L, Rosenfeld A, Fernandes AR, Natour J. Accuracy of intra-articular injections in peripheral joints performed blindly in patients with rheumatoid arthritis. Rheumatology (Oxford). 2008;47:1792–1794
  24. Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33:73–81
  25. Mathews PV, Glousman RE. Accuracy of subacromial injection: anterolateral versus posterior approach. J Shoulder Elbow Surg. 2005;14:145–148
  26. Meislin RJ, Sperling JW, Stitik TP. Persistent shoulder pain: epidemiology, pathophysiology, and diagnosis. Am J Orthop (Belle Mead NJ). 2005;34:5–9PMID:16450690
  27. Melzack R. The short-form McGill Pain Questionnaire. Pain. 1987;30:191–197
  28. Melzack R, Katz J. The McGill Pain Questionnaire: appraisal and current status. In:  Turk D,  Melzack R editor. Handbook of pain assessment. New York: Guilford Press; 2001;p. 659–692
  29. Naredo E, Cabero F, Beneyto P, Cruz A, Mondejar B, Uson J, et al. A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder. J Rheumatol. 2004;31:308–314PMID:14760802
  30. Partington PF, Broome GH. Diagnostic injection around the shoulder: hit and miss? A cadaveric study of injection accuracy. J Shoulder Elbow Surg. 1998;7:147–150
  31. Price DD, Bush FM, Long S, Harkins SW. A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain. 1994;56:217–226
  32. Rizk TE, Pinals RS, Talaiver AS. Corticosteroid injections in adhesive capsulitis: investigation of their value and site. Arch Phys Med Rehabil. 1991;72:20–22PMID:1985618
  33. Roy JS, MacDermid JC, Woodhouse LJ. Measuring shoulder function: a systematic review of four questionnaires. Arthritis Rheum. 2009;61:623–632
  34. Rutten MJ, Maresch BJ, Jager GJ, de Waal Malefijt MC. Injection of the subacromial-subdeltoid bursa: blind or ultrasound-guided?. Acta Orthop. 2007;78:254–257
  35. Schmitt JS, Di Fabio RP. Reliable change and minimum important difference (MID) proportions facilitated group responsiveness comparisons using individual threshold criteria. J Clin Epidemiol. 2004;57:1008–1018
  36. Sethi PM, Kingston S, Elattrache N. Accuracy of anterior intra-articular injection of the glenohumeral joint. Arthroscopy. 2005;21:77–80
  37. Skedros JG, Hunt KJ, Pitts TC. Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians. BMC Musculoskelet Disord. 2007;8:63
  38. Vecchio PC, Hazleman BL, King RH. A double-blind trial comparing subacromial methylprednisolone and lignocaine in acute rotator cuff tendinitis. Br J Rheumatol. 1993;32:743–745
  39. Weiss JJ, Ting YM. Arthrography-assisted intra-articular injection of steroids in treatment of adhesive capsulitis. Arch Phys Med Rehabil. 1978;59:285–287PMID: 666560
  40. Winters JC, Sobel JS, Groenier KH, Arendzen JH, Meyboom-de Jong B. The long-term course of shoulder complaints: a prospective study in general practice. Rheumatology (Oxford). 1999;38:160–163
  41. Withrington RH, Girgis FL, Seifert MH. A placebo-controlled trial of steroid injections in the treatment of supraspinatus tendonitis. Scand J Rheumatol. 1985;14:76–78
  42. Yamakado K. The targeting accuracy of subacromial injection to the shoulder: an arthrographic evaluation. Arthroscopy. 2002;18:887–891

 Mary Black Healthcare System IRB # HS-29.

 Greenville Regional Health System IRB # 10-07-09.

PII: S1058-2746(10)00126-6

doi: 10.1016/j.jse.2010.03.014

Journal of Shoulder and Elbow Surgery
Volume 19, Issue 6 , Pages 795-801 , September 2010