Ultrasound-guided subacromial-subdeltoid bursa corticosteroid injections: a study of short- and long-term outcomes

Comparison of the Effects of Ultrasound-Guided Subacromial Injection Versus Subacromial Injection and Suprascapular Nerve Block on Pain, Function, and Sleep Quality in Rotator Cuff Lesions

Background/Objectives: Rotator cuff lesions are common causes of shoulder pain. When not treated effectively, the functional loss associated with pain affects the quality of life and brings about psychosocial issues. In this study, prospective observational comparison of the effects of ultrasonography (USG) guided subacromial injection (SAI) versus subacromial injection combined with suprascapular nerve block (SSNB) on pain, functionality and sleep quality in the treatment of shoulder pain unresponsive to conservative treatments due to rotator cuff lesions is made. Methods: The data of 25 patients in both groups were compared prospectively. Patients were evaluated after 30 min, 1 week, 2 weeks, 1 month, and 3 months. Pain levels were measured with VAS, shoulder functions with SPADI and sleep quality with PSQI. Analgesic consumption and satisfaction were also recorded. Results: Both treatment groups effectively reduced pain at rest over the 3-month follow-up period. However, the SAI group did not achieve the targeted level of analgesia for pain control during movement. In comparison, the SAI + SSNB group demonstrated significantly superior outcomes, with lower VAS scores both at rest and during motion, as well as improved SPADI and PSQI scores. Additionally, analgesic consumption was significantly reduced in the SAI + SSNB group. No side effects or complications were observed during the treatment applications or the follow-up period. Conclusions: Pain control, shoulder functionality, sleep quality, and patient satisfaction were found to be higher in patients treated with SAI + SSNB in the short-to-medium term in the treatment of shoulder pain due to rotator cuff lesions, in addition to lower analgesic consumption.

A prospective study of 100 patients with rotator cuff tendinopathy showed no correlation between subacromial bursitis and the efficacy of ultrasound-guided corticosteroid injection

OBJECTIVES

The objective of this study was to determine whether the presence of subacromial bursitis in patients with rotator cuff tendinopathy (RCT) was associated with a better outcome after ultrasound (US)-guided subacromial corticosteroid injection.

METHODS

A single-center prospective study was performed including patients referred for subacromial injection to manage RCT. At baseline, all patients received an US-guided intra-bursal injection of betamethasone (1 ml). The primary endpoint was reduced pain 3 months (M3) after the procedure: a good responder was defined by a decrease in Visual Analogue Scale pain of more than 30%. Secondary endpoints included functional recovery assessed by the Oxford Shoulder Score (OSS) and clinical success at 6 weeks (W6). We also explored the association between good clinical response and other factors, such as US or X-ray features.

RESULTS

One hundred patients were included and 49 presented with subacromial bursitis. At M3, 60% of patients (54/100) were considered good responders. The rate of good responders did not differ between the bursitis and non-bursitis groups (p = 0.6). During follow-up, OSS improved over time whether bursitis was present or not. We did not find any US or X-ray features significantly associated with a favorable clinical outcome.

CONCLUSION

The presence of subacromial bursitis did not influence clinical outcomes at 3 months post-subacromial injection in patients suffering from RCT.

CLINICAL RELEVANCE STATEMENT

The presence of subacromial bursitis did not influence clinical outcomes at 3 months post-subacromial corticosteroid injection in patients with rotator cuff tendinopathy. For patient management, looking for ultrasonographic signs of bursitis does not appear relevant for the indication of the injection.

KEY POINTS

• Ultrasound-guided subacromial corticosteroid injections led to a significant improvement in 60% of patients suffering from rotator cuff tendinopathy. • The presence of subacromial bursitis was not associated with better improvement at 3 months post-injection. • Except for the Minnesota score referring to job satisfaction, we did not find any baseline clinical, X-ray, or ultrasound characteristics associated with a successful outcome.

Ultrasound-guided versus landmark-guided subacromial corticosteroid injections for rotator cuff related shoulder pain: A systematic review of randomised controlled trials

INTRODUCTION

Rotator cuff related shoulder pain (RCRSP) is the most common presentation of shoulder pain within physiotherapy. Corticosteroid injections (CSI) have become increasingly popular to reduce pain, increase range of motion (ROM) and improve shoulder function. Evidence around the use of ultrasound-guided (USG) versus landmark-guided (LMG) CSIs remains controversial.

OBJECTIVE

The objective of this appraisal was to compare the effectiveness of each approach in the management of RCRSP.

METHODS

Cochrane, PubMed and CINAHL electronic databases were searched (from January 2014 to February 2021). Randomised controlled trials (RCTs) were included comparing USG to LMG CSIs for RCRSP. An independent reviewer selected the studies, extracted and synthesised the data. Two reviewers carried out a quality appraisal. Outcome measures were pain, function and ROM.

RESULTS

Four RCTs (n = 179 participants, n = 184 shoulders) were reviewed. Both USG and LMG groups showed statistically significant within group improvements in clinical outcomes. There were no significant differences between groups. Three studies were identified as being a 'low' risk of bias (RoB) and did not favour the use of ultrasound. One study did favour the use of ultrasound for improving function, although it was found to have 'high' RoB. Adverse events were seldom reported.

CONCLUSION

There is limited evidence to suggest using USG CSIs has a superior effect on clinical outcomes compared to LMG, though small sample sizes and lack of long-term follow-up limit the generalisability of the findings.

Interventional Radiology Procedures of the Shoulder

Using imaging guidance to perform procedures around the shoulder girdle has become established practice in musculoskeletal radiology. Whether it be therapeutic injections for intra-articular pathology, rotator cuff or subacromial/subdeltoid bursal pathology, or injections for diagnostic purposes, such as magnetic resonance or computed tomography arthrography, a range of techniques and imaging modalities can be used. This article discusses the techniques for commonly performed procedures.

The Effectiveness of Ultrasound-Guided Subacromial-Subdeltoid Bursa Combined With Long Head of the Biceps Tendon Sheath Corticosteroid Injection for Hemiplegic Shoulder Pain: A Randomized Controlled Trial

Background

Subacromial-subdeltoid (SASD) bursa and long head of the biceps tendon (LHBT) sheath corticosteroid injection are commonly used to treat shoulder pain associated with arthritic shoulder conditions, but effectiveness in the stroke population is unclear. This study aimed to investigate the clinical effectiveness of ultrasound-guided SASD bursa combined with LHBT sheath corticosteroid injection for hemiplegic shoulder pain (HSP) compared with SASD bursa injection alone.

Methods

60 patients with HSP were randomly allocated to the dual-target group (n = 30) and single-target group (n = 30). The single-target group received SASD bursa corticosteroid injection alone, and the dual-target group received SASD bursa and LHBT sheath corticosteroid injection. The primary endpoint was pain intensity measured on a visual analog scale (VAS). The secondary endpoint was passive range of motion (PROM) of the shoulder, Upper Extremity Fugl-Meyer assessment (UEFMA) score, and Modified Barthel Index (MBI) score. PROM and pain intensity VAS were assessed at baseline and weeks 1, 4, and 12 post-treatment. UEFMA and MBI were recorded at baseline and weeks 4 and 12 post-treatment.

Results

A total of 141 patients with HSP were screened, and 60 patients were included. Significant differences in the VAS, PROM, UEFMA and MBI were observed at all follow-ups in both groups. The dual-target group showed a significant difference in VAS score compared with the single-target group (3.3 vs. 3.7, p = 0.01) at week 4 and week 12 (2.5 vs. 3.2, p < 0.001). Moreover, the dual-target group showed statistically significant differences in flexion (p < 0.001) at week 12, extension rotation (p < 0.001) at week 12, and abduction at week 1 (p = 0.003) and weeks 4 and 12 (p < 0.001) compared with the single-target group. There were significant differences in FMA and MBI scores in the two groups before and after treatment (p < 0.001), with a more significant increase in the dual-target group compared with the single-target group (p < 0.001) at week 12.

Conclusion

The combination of SASD bursa and LHBT sheath corticosteroid injection is superior to SASD bursa injection alone in reducing shoulder pain and improving functional activities in patients with HSP.

Clinical Trial Registration

www.chictr.org.cn, Unique identifier: ChiCTR2100047125.

Upper Limb Interventions

Ultrasound has been reported to be a quick, cheap, and effective imaging modality to guide the interventional procedures in the musculoskeletal system. The use of ultrasound results in increased accuracy of needle placement associated with a reduction of complications. In the upper limb, ultrasound-guided procedures are applied to joints and soft tissues around the shoulder, elbow, wrist, and hand. This article reviews the clinical and technical aspects of the most common procedures performed in this anatomic area.