In many instances , no or minimal attempts to screen were undertaken or reported .
Background Subacromial shoulder pain is a common clinical presentation with much diagnostic uncertainty .
Some of this uncertainty relates to the involvement of the cervical spine as a source or contribution to subacromial shoulder pain .
Currently , there is no accepted method of screening of the cervical spine in the presence of subacromial shoulder pain , which risks patients receiving misguided and /or ineffective interventions .
Objective To evaluate approaches used to screen the cervical spine in patients with subacromial shoulder pain .
A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder.
OBJECTIVE Local corticosteroid injections , commonly accepted by rheumatologists to be effective treating painful shoulder , have shown controversial results . High frequency ultrasonography is an accurate and safe imaging modality for guiding musculoskeletal injections . We prospect ively compared the short term response to r and omized blind injection versus sonographic-guided injection of local corticosteroid in patients with painful shoulder . METHODS We studied 41 consecutive patients with painful shoulder . Patients with previous trauma or chronic inflammatory arthritis were excluded . No patient had received previous physiotherapy or local steroid injection in the shoulder . Patients were r and omized to receive either a blind subacromial injection of 20 mg triamcinolone ( Group 1 , n = 20 ) or a sonographic guided injection of 20 mg triamcinolone ( Group 2 , n = 21 ) by the same rheumatologist blinded to the clinical evaluation . In both groups we recorded shoulder abnormalities and the location of the steroid postinjection by ultrasound . Each patient was clinical ly assessed within 5 days before injection and 6 weeks after injection by another rheumatologist without knowledge of the injection technique performed . Clinical assessment included demographic and clinical data , a visual analog scale ( VAS ) for pain ( 0 - 100 ) , the Shoulder Function Assessment ( SFA ) scale ( 0 - 70 ) , and postinjection adverse effects . No patient received physical therapy during the followup period . Initially , demographic , clinical , and ultrasonographic findings in both groups showed no significant differences . RESULTS Six weeks after injection , the VAS and the SFA score showed a significantly greater improvement in Group 2 compared with Group 1 ( mean VAS score change 34.9 for Group 2 vs 7.1 for Group 1 , p < 0.001 ; and mean SFA score change 15 for Group 2 vs 5.6 for Group 1 , p = 0.012 ) . One patient in Group 1 reported mild postinjection adverse effects . CONCLUSION We suggest that sonographic-guided corticosteroid injections should be indicated , at least , in patients with poor response to previous blind injection to ensure accurate medication placement in order to improve therapeutic effectiveness
In many instances , no or minimal attempts to screen were undertaken or reported .
Background Subacromial shoulder pain is a common clinical presentation with much diagnostic uncertainty .
Some of this uncertainty relates to the involvement of the cervical spine as a source or contribution to subacromial shoulder pain .
Currently , there is no accepted method of screening of the cervical spine in the presence of subacromial shoulder pain , which risks patients receiving misguided and /or ineffective interventions .
Objective To evaluate approaches used to screen the cervical spine in patients with subacromial shoulder pain .