title: Impact of outpatient clinic ultrasound imaging in the diagnosis and treatment for shoulder impingement: a randomized prospective study.
abstract: The use of musculoskeletal ultrasonography (MSUS) in guiding subdeltoid injection has been shown to improve outcome up to 6 weeks in a few small studies. A recent meta-analysis identified the need for further studies with longer-term outcome and larger sample size. This randomized prospective study assessed whether clinic-based MSUS can significantly improve diagnostic accuracy in shoulder pain and whether MSUS-guided shoulder injection results in improved long-term outcomes. One hundred consecutive patients with 125 painful shoulders were recruited. Patients were randomized to receive either sonographic assessment with consequent palpation-guided injection (Group 1, n = 66) or sonographic assessment with a MSUS-guided injection of 40 mg of methylprednisolone acetate (Group 2, n = 59). A blinded rheumatologist (ADF) performed clinical assessments at baseline, 6 and 12 weeks including shoulder function tests (SFTs) (Hawkins-Kennedy test, supraspinatus tendon tenderness), physician global assessment (PGA) and patient visual analogue scores (VAS) for pain (0-10). Eighty patients with 90 symptomatic shoulders completed 12-week follow-up. Twenty patients, 11 (20 shoulders) from the palpation-guided group and 9 (15 shoulders) from the MSUS-guided group, were excluded at 6 weeks either due to requirement for repeat injection or due to surgical referral. Mean age for patients was 57.7 years, and 65 % patients were female; mean shoulder pain duration was 18 weeks (range 14-22 weeks). SFTs, patient VAS and PGA scores for pain improved significantly from baseline in both groups with significantly greater improvements in the MSUS-guided group (44 shoulders) compared to the palpation-guided group (46 shoulders) in all parameters at 6 (p < 0.01) and 12 weeks (p < 0.05). The use of MSUS in guiding subdeltoid injection has been shown to improve outcome up to 6 weeks in a few small studies. A recent meta-analysis identified the need for further studies with longer-term outcome and larger sample size.
authors.affiliation: Department of Rheumatology, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland, modelian@gmail.com.
authors.forename: Aamir
authors.initials: A
authors.lastname: Saeed
authors.forename: Mumtaz
authors.initials: M
authors.lastname: Khan
authors.forename: Siobhan
authors.initials: S
authors.lastname: Morrissey
authors.forename: David
authors.initials: D
authors.lastname: Kane
authors.forename: Alexander Duncan
authors.initials: AD
authors.lastname: Fraser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001696:Biomechanical Phenomena; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D007494:Ireland; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012782:Shoulder / Q000000981:diagnostic imaging* / Q000503:physiopathology; D019534:Shoulder Impingement Syndrome / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000503:physiopathology; D020069:Shoulder Pain / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000503:physiopathology; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D000077555:Methylprednisolone Acetate; D008775:Methylprednisolone