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Is Ultrasound-Guided Injection More Effective in Chronic Subacromial Bursitis?

HSIEH, LIN-FEN1,2; HSU, WEI-CHUN3,4; LIN, YI-JIA3,5; WU, SHIH-HUI6; CHANG, KAE-CHWEN1; CHANG, HSIAO-LAN1

Medicine & Science in Sports & Exercise: December 2013 - Volume 45 - Issue 12 - p 2205–2213
doi: 10.1249/MSS.0b013e31829b183c
Clinical Sciences

Purpose: Although ultrasound (US)-guided subacromial injection has shown increased accuracy in needle placement, whether US-guided injection produces better clinical outcome is still controversial. Therefore, this study aimed to compare the efficacy of subacromial corticosteroid injection under US guidance with palpation-guided subacromial injection in patients with chronic subacromial bursitis.

Methods: Patients with chronic subacromial bursitis were randomized to a US-guided injection group and a palpation-guided injection group. The subjects in each group were injected with a mixture of 0.5 mL dexamethasone suspension and 3 mL lidocaine into the subacromial bursa. The primary outcome measures were the visual analog scale for pain and active and passive ranges of motion of the affected shoulder. Secondary outcome measures were the Shoulder Pain and Disability Index, the Shoulder Disability Questionnaire, and the 36-item Short-Form Health Survey (SF-36). The primary outcome measures were evaluated before, immediately, 1 wk, and 1 month after the injection; the secondary outcome measures were evaluated before, 1 wk, and 1 month after the injection.

Results: Of the 145 subjects screened, 46 in each group completed the study. Significantly greater improvement in passive shoulder abduction and in physical functioning and vitality scores on the SF-36 were observed in the US-guided group. The pre- and postinjection within-group comparison revealed significant improvement in the visual analog scale for pain and range of motion, as well as in the Shoulder Pain and Disability Index, Shoulder Disability Questionnaire, and SF-36 scores, in both groups.

Conclusions: The US-guided subacromial injection technique produced significantly greater improvements in passive shoulder abduction and in some items of the SF-36. US is effective in guiding the needle into the subacromial bursa in patients with chronic subacromial bursitis.

1Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, TAIWAN; 2School of Medicine, Fu Jen Catholic University, New Taipei City, TAIWAN; 3Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, TAIWAN; 4Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, TAIWAN; 5Department and Graduate Institute of Physical Education and Health, University of Taipei, Taipei, TAIWAN; and 6Department of Physical Medicine and Rehabilitation, Cardinal Tien Hospital, New Taipei City, TAIWAN

Address for correspondence: Lin-Fen Hsieh, M.D., Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shin Lin District, Taipei 111, Taiwan; E-mail: M001026@ms.skh.org.tw; reh6110@yahoo.com.tw.

Submitted for publication January 2013.

Accepted for publication May 2013.

© 2013 American College of Sports Medicine