title: Injection of the subacromial-subdeltoid bursa: blind or ultrasound-guided?
abstract: BACKGROUND
  Blind injection of the subacromial-sub-deltoid bursa (SSB) for diagnostic purposes (Neer test) or therapeutic purposes (corticosteroid therapy) is frequently used. Poor response to previous blind injection or side effects may be due to a misplaced injection. It is assumed that ultrasound (US)-guided injections are more accurate than blind injections. In a randomized study, we compared the accuracy of blind injection to that of US-guided injection into the SSB.
  
  
  METHODS
  20 consecutive patients with impingement syndrome of the shoulder were randomized for blind or US-guided injection in the SSB. Injection was performed either by an experienced orthopedic surgeon or by an experienced musculoskeletal radiologist. A mixture of 1 m'L methylprednisolone acetate, 4 mL prilocaine hydrochloride and 0.02 mL (0.01 mmol) Gadolinium DTPA was injected. Immediately after injection, a 3D-gradient T1-weighted magnetic resonance scan of the shoulder was performed. The location of the injected fluid was independently assessed by 2 radiologists who were blinded as to the injection technique used.
  
  
  RESULTS
  The accuracy of blind and US-guided injection was the same. The fluid was injected into the bursa in all cases.
  
  
  CONCLUSIONS
  Blind injection into the SSB is as reliable as US-guided injection and could therefore be used in daily routine. US-guided injections may offer a useful alternative in difficult cases, such as with changed anatomy postoperatively or when there is no effective clinical outcome.
authors.affiliation: Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
authors.forename: Matthieu J C M
authors.initials: MJ
authors.lastname: Rutten
authors.forename: Bas J
authors.initials: BJ
authors.lastname: Maresch
authors.forename: Gerrit J
authors.initials: GJ
authors.lastname: Jager
authors.forename: Maarten C
authors.initials: MC
authors.lastname: de Waal Malefijt
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D002061:Bursa, Synovial / Q000000981:diagnostic imaging; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077555:Methylprednisolone Acetate; D011318:Prilocaine / Q000008:administration & dosage; D019534:Shoulder Impingement Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014463:Ultrasonography
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D003287:Contrast Media; D011318:Prilocaine; D000077555:Methylprednisolone Acetate; D019786:Gadolinium DTPA; D008775:Methylprednisolone