Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original articleThe Accuracy of Subacromial Injections: A Prospective Randomized Magnetic Resonance Imaging Study
Section snippets
Methods
Thirty-three patients with subacromial pain were included in the study. There where 11 men and 22 women with an average age of 46 years (range, 25 to 64 years). Subacromial impingement was diagnosed when patients complained of nontraumatic shoulder pain localized to the deltoid region with an inability to lie on the affected side. Furthermore, pain provocation was present when movements of abduction, retroversion, or internal rotation in the glenohumeral joint against resistance were performed.
Results
There was no lack of consensus between the 2 radiologists. No shoulder had evidence of a full-thickness rotator cuff rupture on the MRI. No differences were found among groups, including gender, age, Simple Shoulder, Constant, and VAS scores. The average BMI was 26 (minimum, 18; maximum, 33) for the posterior injected group and 27 (minimum, 20; maximum, 44) for the anteromedial injected group (Table 1).
The injection confidence of the orthopaedic surgeon was high. With the posteromedial
Discussion
Injections with a local anesthetic around the shoulder are widely used in the diagnostic process of shoulder pain. Neer’s impingement test describes the reaction of the patient after infiltration of the subacromial bursa and is used in the decision-making if an acromioplasty is considered.2, 3 Searching for factors influencing the result after subacromial decompression, Patel et al.10 associated a positive impingement test with a satisfactory result after acromioplasty. However, Kirkley et al.11
Conclusions
We conclude that injections given in the subacromial bursa for diagnostic or therapeutic use, without any radiological support, are inaccurate, despite the confident feeling of the clinician. In this study, the accuracy was only 66%. The many different structures hit with 1 injection can create both false-positive and -negative results. This makes the diagnostic use of local injections in the subacromial bursa a poor tool.
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