title: Should we continue to administer blind shoulder injections?
abstract: OBJECTIVE
  This study aims to investigate the accuracy and effectiveness of blind and fluoroscopic-guided intra-articular shoulder injections in patients with shoulder pain.
  
  
  METHODS
  The study included 17 patients (6 males, 11 females; mean age 52.6±9.9 years; range 36 to 66 years) with shoulder pain more than three months. First intra-articular joint injections were performed with anterior approach blindly. Following the injection and after confirming that the needle tip was intra-articular with fluoroscopy and contrast distribution, the procedure was completed using 3 mL of local anesthetic (prilocaine and bupivacaine) and 1 mL of steroid (40 mg methylprednisolone). When the contrast distribution was observed to be extra-articular at the first administration, a second injection was continued under fluoroscopy guidance. All of the injections were intra-articular with the continuation of the procedure. Pain intensity was measured with visual analog scale (VAS).
  
  
  RESULTS
  According to the contrast distribution viewed with fluoroscopy, first blind injections were intra-articular in 11 of the 17 shoulders (64.7%). Mean of initial VAS score was 7.11. Improved pain was observed in the clinical follow-ups at the first hour (mean VAS: 2.35), third day (mean VAS: 2.64), and at the end of the first month (mean VAS: 2.23). The mean durations for blind and fluoroscopic-guided procedures excluding patients' preparation time were 0.8 minutes and 4.2 minutes, respectively.
  
  
  CONCLUSIONS
  Although blind intra-articular shoulder injections are inexpensive and easily applicable, injections should be performed under fluoroscopy or another guide to ensure that the needle is intra-articular, not peri-articular.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Medical Faculty of İstanbul Medipol University, 34214 Bağcılar, İstanbul, Turkey. mehmetagirman@yahoo.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ağırman
authors.forename: Merve Akdeniz
authors.initials: MA
authors.lastname: Leblebicier
authors.forename: Oğuz
authors.initials: O
authors.lastname: Durmuş
authors.forename: İlknur
authors.initials: İ
authors.lastname: Saral
authors.forename: Osman Hakan
authors.initials: OH
authors.lastname: Gündüz
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007270:Injections, Intra-Articular / Q000009:adverse effects / Q000379:methods; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D020069:Shoulder Pain / Q000175:diagnosis / Q000188:drug therapy; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone; D002045:Bupivacaine