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Intra-Articular Versus Periarticular Acromioclavicular Joint Injection: A Multicenter, Prospective, Randomized, Controlled Trial

Published:October 21, 2013DOI:https://doi.org/10.1016/j.arthro.2013.08.027

      Purpose

      The purpose of this randomized study was to compare the clinical efficacy of intra-articular versus periarticular acromioclavicular joint injections.

      Methods

      In this multicenter, prospective, randomized, controlled trial, 101 patients (106 shoulders) with symptomatic acromioclavicular joints were treated with an injection and were randomly assigned to either the intra-articular group or the periarticular group. To ensure accurate needle placement either intra-articularly or in a periarticular manner, the needle was placed under ultrasound guidance. Baseline values including the Constant-Murley score, pain assessment with a visual analog scale for pain under local pressure and pain at night, and the crossover arm test were investigated in 7 different centers immediately before treatment. Follow-up examinations were scheduled after 1 hour, 1 week, and 3 weeks.

      Results

      All patients completed the study. Overall, a highly significant clinical improvement in all tested variables and in both groups was observed over time (P < .0001) beginning with 1 hour after treatment and lasting for the entire follow-up period of 3 weeks. The difference between the 2 groups was not significant except regarding the crossover arm test (P < .016).

      Conclusions

      With both injection techniques, a highly significant clinical advantage for the patient can be achieved. The difference between the 2 treatments was not significant except for more pain reduction according to the crossover arm test after intra-articular injection at 3 weeks' follow-up.

      Level of Evidence

      Level II, multicenter, randomized, prospective, controlled trial.
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      References

        • Bain G.I.
        • van Riet R.P.
        • Gooi C.
        • Ashwood N.
        The long-term efficacy of corticosteroid injection into the acromioclavicular joint using a dynamic fluoroscopic method.
        Int J Shoulder Surg. 2007; 1: 104-107
        • Bradley J.P.
        • Elkousy H.
        Decision making: Operative versus nonoperative treatment of acromioclavicular joint injuries.
        Clin Sports Med. 2003; 22: 277-290
        • Jacob A.K.
        • Sallay P.I.
        Therapeutic efficacy of corticosteroid injections in the acromioclavicular joint.
        Biomed Sci Instrum. 1997; 34: 380-385
        • Partington P.F.
        • Broome G.H.
        Diagnostic injection around the shoulder: Hit and miss? A cadaveric study of injection accuracy.
        J Shoulder Elbow Surg. 1998; 7: 147-150
        • Sabeti-Aschraf M.
        • Ochsner A.
        • Schueller-Weidekamm C.
        • et al.
        The infiltration of the AC joint performed by one specialist: Ultrasound versus palpation a prospective pilot study.
        Eur J Radiol. 2010; 75: e37-e40
        • Shaffer B.S.
        Conditions of the acromioclavicular joint.
        J Am Acad Orthop Surg. 1999; 7: 176-188
        • Peck E.
        • Lai J.K.
        • Pawlina W.
        • Smith J.
        Accuracy of ultrasound-guided versus palpation-guided acromioclavicular joint injections: A cadaveric study.
        PM R. 2010; 2: 817-821
        • Bisbinas I.
        • Belthur M.
        • Said H.G.
        • Green M.
        • Learmouth D.J.
        Accuracy of needle placement in ACJ injections.
        Knee Surg Sports Traumatol Arthrosc. 2006; 14: 762-765
        • Constant C.R.
        • Murley A.H.
        A clinical method of functional assessment of the shoulder.
        Clin Orthop Relat Res. 1987; : 160-164
        • Pichler W.
        • Weinberg A.M.
        • Grechenig S.
        • et al.
        Intra-articular injection of the acromioclavicular joint.
        J Bone Joint Surg Br. 2009; 91: 1638-1640
        • Sabeti-Aschraf M.
        • Lemmerhofer B.
        • Lang S.
        • et al.
        Ultrasound guidance improves significantly the accuracy of the acromioclavicular joint infiltration: A prospective randomized study.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 292-295
        • Borbas P.
        • Kraus T.
        • Clement H.
        • et al.
        The influence of ultrasound guidance in the rate of success of acromioclavicular joint injection: An experimental study on human cadavers.
        J Shoulder Elbow Surg. 2012; 21: 1695-1697
        • Wasserman B.R.
        • Pettrone S.
        • Laith M.
        • et al.
        Accuracy of acromioclavicular joint injections.
        Am J Sports Med. 2013; 41: 149-152