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.
Key Words
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© 2006 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
