Close is Close Enough in Steroid Injections of Shoulder

Just got back from a course showing how to give ultrasound guided injections so you can hit the right spot.  Now it appears you don’t need to be close at least for shoulders…

J Shoulder Elbow Surg (2010) 19, 795-801
Positive outcomes with intra-articular glenohumeral injections are independent of accuracy
Eric J. Hegedus, DPT, MHSca,*, John Zavala, MDb, Michael Kissenberth, MDc,d, Chad Cook, PT, PhD, MBAa, Kyle Cassas, MDb,d, Richard Hawkins, MD, Allison Tobola  abstract here

  • blinded, longitudinal observational design
  • Only 52.4% of shoulder injections are actually in the capsule
  • improvements were typically 2.5 points on the 1-10 scale
  • Improvements were independent of whether the joint was hit.

To make this worse, you can be as far off the shoulder as putting it in the butt, and it still works:

BMJ. 2009 Jan 23;338:
Subacromial ultrasound guided or systemic steroid injection for rotator cuff disease: randomised double blind study.
Ekeberg OM, Bautz-Holter E, Tveitå EK, Juel NG, Kvalheim S, Brox JI. free article here

Compared steroid given in butt to steroid injected into shoulder –  no significant difference

  • 20 mg Kenalog to butt and local anesthetic to shoulder versus local and kenalog to shoulder and local into the butt
  • Local ultrasound guided corticosteroid injection is unlikely to be substantially more effective than systemic corticosteroid injection for short term improvement of pain and disability in rotator cuff disease

Another study:
Yamakado K.
The targeting accuracy of subacromial injection to the
shoulder: an arthrographic evaluation.
Arthroscopy 2002;18:887-91.

Found only 79% of subdeltoid injections reached this space – deltoid muscle or shoulder joint injection were possibilities – Neer and Hawkin’s tests after injection were similarly improved however.

  • Comment – well, there goes another God – this time the need for Ultrasound guided injections – at least into the shoulder… I remember when I started using Botulinum injections into knee joints – the joint would be fine after but I was shocked to find the tissues around it were still sore – especially the arsensine bursa – Steroid injection effects spread far… – Botox does not.

  • C

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