Purpose: To assess the accuracy of shoulder infiltrations in the subacromial bursa (SAB) by a posterior or an anteromedial approach. Magnetic resonance imaging (MRI) and clinical outcome were used for evaluation. Type of Study: A prospective randomized study. Methods: Thirty-three patients (22 women, 11 men; average age, 46 years; range, 25 to 64 years) with clinical signs of subacromial impingement were infiltrated with a mixture of bupivacaine, methylprednisolone, and gadolinium-DTPA directly followed by MRI to determine the actual site of injection. The SAB was randomly infiltrated posteriorly (n = 17) or anteromedially (n = 16). Injection confidence of the surgeon and body-mass index of the patient were recorded. Follow-up consisted of the Constant Score, Simple Shoulder Test, and visual analog scale score for pain taken within 24 hours and 6 weeks after infiltration. Results: Thirteen injections (76%) were in the SAB with a posterior approach and 10 (69%) with an anteromedial approach. Many surrounding structures were hit as well, especially the rotator cuff. A positive correlation between the injection confidence of the orthopaedic surgeon and the MRI was found in 66%. Only injection of the SAB alone resulted in a significant decrease of the pain (P = .004) and an increase in the functional scores. Injection in the bursa and rotator cuff muscle showed a significant increase in pain (P = .032) but no change in clinical scores. The body mass index had no influence on the scores. Conclusions: Injections in the SAB are inaccurate, despite the confident feeling of the clinician. The finding that many different structures can be infiltrated with 1 injection can create both false-positive and -negative results. Level of Evidence: Level II.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Arthroscopy
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Anterior acromioplasty for the chronic impingement syndrome in the shoulder.J Bone Joint Surg Am. 1972; 54: 41-50
- Impingement lesions.Clin Orthop. 1983; 173: 70-77
- Arthroscopic versus open acromioplasty.J Shoulder Elbow Surg. 2002; 11: 101-107
- Steroid injections for shoulder disorders.Br J Gen Pract. 1996; 46: 309-316
- Corticosteroid injections for shoulder pain.Cochrane Database Syst Rev. 2003; 1 (CD004016)
- Tendon rupture after local steroid injection.South Med J. 1979; 72: 827-830
- Achilles tendon rupture following steroid injection. Report of three cases.J Bone Joint Surg Am. 1983; 65: 1345-1347
- The effects of intratendinous and retrocalcaneal intrabursal injections of corticosteroid on the biomechanical properties of rabbit Achilles tendons.J Bone Joint Surg Am. 2004; 86: 794-801
- The effect of the local corticosteroids on the healing and biomechanical properties of the partially injured tendon.Clin Orthop. 1982; 163: 170-179
- Arthroscopic subacromial decompression.J Shoulder Elbow Surg. 1999; 8: 231-237
- The use of the impingement test as a predictor of outcome following subacromial decompression for rotator cuff tendinosis.Arthroscopy. 2002; 18: 8-15
- Steroid injection technique.Clin Orthop. 1997; 334: 383-384
- Diagnostic injection around the shoulder: Hit and miss? A cadaveric study of injection accuracy.J Shoulder Elbow Surg. 1998; 7: 147-150
- Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms.Ann Rheum Dis. 1997; 56: 59-63
- Accuracy of anterior intra-articular injection of the glenohumeral joint.Arthroscopy. 2005; 21: 77-80
- The targeting accuracy of subacromial injection to the shoulder.Arthroscopy. 2002; 18: 887-891
© 2006 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.