title: Intra-articular versus periarticular acromioclavicular joint injection: a multicenter, prospective, randomized, controlled trial.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Level II, multicenter, randomized, prospective, controlled trial.
authors.affiliation: Department for Orthopaedics and Orthopaedic Surgery, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria. Electronic address: manuel.sabeti-aschraf@meduniwien.ac.at.
authors.forename: Manuel
authors.initials: M
authors.lastname: Sabeti-Aschraf
authors.forename: Christoph
authors.initials: C
authors.lastname: Stotter
authors.forename: Christoph
authors.initials: C
authors.lastname: Thaler
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Kristen
authors.forename: Maximilian
authors.initials: M
authors.lastname: Schmidt
authors.forename: Rolf Michael
authors.initials: RM
authors.lastname: Krifter
authors.forename: Michael
authors.initials: M
authors.lastname: Hexel
authors.forename: Roman
authors.initials: R
authors.lastname: Ostermann
authors.forename: Thomas
authors.initials: T
authors.lastname: Hofstaedter
authors.forename: Alexandra
authors.initials: A
authors.lastname: Graf
authors.forename: Reinhard
authors.initials: R
authors.lastname: Windhager
mesh_terms: D000173:Acromioclavicular Joint / Q000503:physiopathology; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007270:Injections, Intra-Articular / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000188:drug therapy*; D010147:Pain Measurement; D011446:Prospective Studies; D016059:Range of Motion, Articular; D016896:Treatment Outcome