title: High volume image guided injections and structured rehabilitation in shoulder impingement syndrome: a retrospective study.
abstract: BACKGROUND
  the aim was to establish the effect of a high volume-image guided injection and structured rehabilitation (HVIGI&SR) on both pain and function in shoulder impingement syndrome (SIS).
  
  
  METHODS
  44 participants treated between January 2008 and January 2012 with a >3 month history of recalcitrant ultrasound-confirmed SIS were sent a retrospective questionnaire. All participants had received a HVIGI under ultrasound-guidance consisting of 20 mls of Marcaine with 50 mg of hydrocortisone, followed by a period of physiotherapist-led rehabilitation. The validated Shoulder Pain and Disability Index (SPADI) score was used to establish the change in the score between 1 week pre-injection and 3 weeks post-injection, along with an 11-point pain scale.
  
  
  RESULTS
  59% of participants responded. There was a clinically and statistically significant decrease in the SPADI score of 58.7 ± 29.9 (p<0.01). 76% of participants had an improvement in their score of over 50% from their initial score. There was a clinically and statistically significant improvement in pain of 5.19 ± 2.62 (p<0.01) on the numerical rating scale of pain.
  
  
  CONCLUSIONS
  HVIGI&SR should be considered for short-term treatment of SIS as it showed a significant improvement in both pain and function. A prolonged period of physiotherapist-led rehabilitation can then be undertaken for long term benefits.
authors.affiliation: Centre for Sports and Exercise Medicine William Harvey Research Institute Queen Mary University of London Mile End Hospital, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Morton
authors.affiliation: BMI London Independent Hospital, London, UK.
authors.forename: Otto
authors.initials: O
authors.lastname: Chan
authors.affiliation: Centre for Sports and Exercise Medicine William Harvey Research Institute Queen Mary University of London Mile End Hospital, London, UK.
authors.forename: Asser
authors.initials: A
authors.lastname: Ghozlan
authors.affiliation: Centre for Sports and Exercise Medicine William Harvey Research Institute Queen Mary University of London Mile End Hospital, London, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Price
authors.affiliation: Centre for Sports and Exercise Medicine William Harvey Research Institute Queen Mary University of London Mile End Hospital, London, UK ; BMI London Independent Hospital, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Perry
authors.affiliation: Centre for Sports and Exercise Medicine William Harvey Research Institute Queen Mary University of London Mile End Hospital, London, UK ; BMI London Independent Hospital, London, UK ; Physiotherapy Department, Bart's Health NHS Trust, London, UK.
authors.forename: Dylan
authors.initials: D
authors.lastname: Morrissey
keywords: SPADI; injection; rotator cuff; ultrasound