title: The clinical and functional outcomes of ultrasound-guided vs landmark-guided injections for adults with shoulder pathology--a systematic review and meta-analysis.
abstract: OBJECTIVE
  To compare the clinical and functional outcomes of US-guided (USG) vs landmark-guided (LMG) injection for the treatment of adults with shoulder pathology.
  
  
  METHODS
  MEDLINE, AMED and Embase in addition to unpublished literature databases were searched from 1950 to August 2011. Studies were included if they were randomized or non-randomized controlled trials comparing USG vs LSG injections for the treatment of adults with shoulder pathology. Two reviewers independently performed data extraction and appraisal of the studies. Meta-analyses were performed where possible and when inappropriate a narrative review of the data was presented.
  
  
  RESULTS
  Six papers including 307 patients were reviewed; 142 received LMG injections and 165 received USG injections. There was a statistically significant difference in favour of USG for pain at 6 weeks (standardized mean difference 1.03; 95% CI 0.12, 1.93; P = 0.03). There was no statistically significant difference between the injection methods with respect to shoulder function (standardized mean difference 0.33; 95% CI -0.59, 1.25; P = 0.48). There was a significant difference between interventions for shoulder abduction at 6 weeks in favour of the USG method (mean difference 2.81; 95% CI 0.67, 4.95; P = 0.01). No other movements showed a statistically significant difference.
  
  
  CONCLUSIONS
  There is a statistically significant difference in pain and abduction between LMG and USG steroid injections for adults with shoulder pathology. However, these differences are small and may not represent clinically useful differences. The current evidence base is limited by a number of important methodological weaknesses, which should be considered when interpreting these findings. The cost-effectiveness of the intervention should be considered in the design of future studies.
authors.affiliation: Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK. w.sage@uea.ac.uk
authors.forename: William
authors.initials: W
authors.lastname: Sage
authors.forename: Luke
authors.initials: L
authors.lastname: Pickup
authors.forename: Toby O
authors.initials: TO
authors.lastname: Smith
authors.forename: Erika R E
authors.initials: ER
authors.lastname: Denton
authors.forename: Andoni P
authors.initials: AP
authors.lastname: Toms
mesh_terms: D000328:Adult; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods*; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D010147:Pain Measurement; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000187:drug effects*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D005938:Glucocorticoids