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
- The long-term efficacy of corticosteroid injection into the acromioclavicular joint using a dynamic fluoroscopic method.Int J Shoulder Surg. 2007; 1: 104-107
- Decision making: Operative versus nonoperative treatment of acromioclavicular joint injuries.Clin Sports Med. 2003; 22: 277-290
- Therapeutic efficacy of corticosteroid injections in the acromioclavicular joint.Biomed Sci Instrum. 1997; 34: 380-385
- Diagnostic injection around the shoulder: Hit and miss? A cadaveric study of injection accuracy.J Shoulder Elbow Surg. 1998; 7: 147-150
- The infiltration of the AC joint performed by one specialist: Ultrasound versus palpation a prospective pilot study.Eur J Radiol. 2010; 75: e37-e40
- Conditions of the acromioclavicular joint.J Am Acad Orthop Surg. 1999; 7: 176-188
- Accuracy of ultrasound-guided versus palpation-guided acromioclavicular joint injections: A cadaveric study.PM R. 2010; 2: 817-821
- Accuracy of needle placement in ACJ injections.Knee Surg Sports Traumatol Arthrosc. 2006; 14: 762-765
- A clinical method of functional assessment of the shoulder.Clin Orthop Relat Res. 1987; : 160-164
- Intra-articular injection of the acromioclavicular joint.J Bone Joint Surg Br. 2009; 91: 1638-1640
- Ultrasound guidance improves significantly the accuracy of the acromioclavicular joint infiltration: A prospective randomized study.Knee Surg Sports Traumatol Arthrosc. 2011; 19: 292-295
- 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
- Accuracy of acromioclavicular joint injections.Am J Sports Med. 2013; 41: 149-152
Article info
Publication history
Published online: October 21, 2013
Accepted:
August 21,
2013
Received:
April 17,
2013
Footnotes
The authors report the following potential conflict of interest or source of funding: Vienna Medical School. Grants from the medical scientific fund of the mayor of the city of Vienna, Gebro Pharma, and Merck, Sharp & Dohme. For every enrolled patient, an honorarium of €50 was paid to the physician and the patient.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
