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Arthroscopy. 2006 Mar;22(3):277-82.

The accuracy of subacromial injections: a prospective randomized magnetic resonance imaging study.

Author information

  • 1Department of Orthopaedics, Medisch Centrum Haaglanden, The Hague, The Netherlands. HHenkus@Planet.nl

Abstract

PURPOSE:

To assess the accuracy of shoulder infiltrations in the subacromial bursa (SAB) by a posterior or an anteromedial approach. Magnetic resonance imaging (MRI) and clinical outcome were used for evaluation.

TYPE OF STUDY:

A prospective randomized study.

METHODS:

Thirty-three patients (22 women, 11 men; average age, 46 years; range, 25 to 64 years) with clinical signs of subacromial impingement were infiltrated with a mixture of bupivacaine, methylprednisolone, and gadolinium-DTPA directly followed by MRI to determine the actual site of injection. The SAB was randomly infiltrated posteriorly (n = 17) or anteromedially (n = 16). Injection confidence of the surgeon and body-mass index of the patient were recorded. Follow-up consisted of the Constant Score, Simple Shoulder Test, and visual analog scale score for pain taken within 24 hours and 6 weeks after infiltration.

RESULTS:

Thirteen injections (76%) were in the SAB with a posterior approach and 10 (69%) with an anteromedial approach. Many surrounding structures were hit as well, especially the rotator cuff. A positive correlation between the injection confidence of the orthopaedic surgeon and the MRI was found in 66%. Only injection of the SAB alone resulted in a significant decrease of the pain (P = .004) and an increase in the functional scores. Injection in the bursa and rotator cuff muscle showed a significant increase in pain (P = .032) but no change in clinical scores. The body mass index had no influence on the scores.

CONCLUSIONS:

Injections in the SAB are inaccurate, despite the confident feeling of the clinician. The finding that many different structures can be infiltrated with 1 injection can create both false-positive and -negative results.

LEVEL OF EVIDENCE:

Level II.

Comment in

PMID:
16517311
[PubMed - indexed for MEDLINE]
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