title: Ultrasound-Guided Versus Blind Subacromial Corticosteroid Injections for Subacromial Impingement Syndrome: A Randomized, Double-Blind Clinical Trial.
abstract: BACKGROUND
  Subacromial corticosteroid injections are frequently performed for impingement syndrome of the shoulder. To improve the accuracy of injections, ultrasound can be used.
  
  
  OBJECTIVE
  To assess the clinical outcome of ultrasound-guided subacromial injections compared with blind subacromial injections for subacromial impingement syndrome.
  
  
  METHODS
  Randomized controlled clinical trial; Level of evidence, 1.
  
  
  METHODS
  A total of 56 shoulders with subacromial impingement syndrome were randomized into 2 groups: 28 shoulders received a subacromial corticosteroid injection with ultrasound guidance (ultrasound group), and 28 shoulders received a subacromial corticosteroid injection without ultrasound guidance (blind group). The visual analog scale (VAS) for pain with overhead activities and the American Shoulder and Elbow Surgeons (ASES) score were obtained before the injection and at 6 weeks after the injection.
  
  
  RESULTS
  The VAS score for pain with overhead activities decreased from 59 ± 5 mm (mean ± SEM) before the injection to 33 ± 6 mm at 6 weeks after the injection in the ultrasound group (P < .001) and from 63 ± 4 mm to 39 ± 6 mm, respectively, in the blind group (P < .001). The decrease in the VAS score was not significantly different between the groups (P > .999). The ASES score increased from 57 ± 2 before the injection to 68 ± 3 at 6 weeks after the injection in the ultrasound group (P < .01) and from 54 ± 3 before the injection to 65 ± 4 after the injection in the blind group (P < .01), with no significant difference between the groups (P = .7). Four shoulders (14%) in the ultrasound group and 6 shoulders (21%) in the blind group eventually needed surgery (P = .7).
  
  
  CONCLUSIONS
  No significant differences were found in the clinical outcome when comparing ultrasound-guided subacromial injections to blind subacromial injections for subacromial impingement syndrome.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry: ACTRN12615000562572.
authors.affiliation: Orthopaedic Research Institute, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Brandi F
authors.initials: BF
authors.lastname: Cole
authors.affiliation: Orthopaedic Research Institute, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Karin S
authors.initials: KS
authors.lastname: Peters
authors.affiliation: Orthopaedic Research Institute, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hackett
authors.affiliation: Orthopaedic Research Institute, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia murrell.g@ori.org.au.
authors.forename: George A C
authors.initials: GA
authors.lastname: Murrell
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D001315:Australia; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods; D008297:Male; D009520:New Zealand; D010147:Pain Measurement; D019534:Shoulder Impingement Syndrome / Q000188:drug therapy*; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000305:Adrenal Cortex Hormones; D005938:Glucocorticoids
keywords: cortisone; injection; shoulder impingement syndrome; ultrasonography