Palpation Versus Ultrasound-Guided
Acromioclavicular Joint Intra-articular
Corticosteroid Injections: A Retrospective
Comparative Clinical Study
Authors: Park Yongbum 
Published: February 2021

Background: Primary osteoarthritis (OA) is the most common cause of pain arising from the
acromioclavicular (AC) joint. The true incidence is unknown because of differences in the criteria used
to define arthritis in various studies. The proper diagnosis of AC joint OA requires a thorough physical
examination, radiographic findings, and a diagnostic local anesthetic injection.
Objective: The goal of this study was to assess the effects and safety of ultrasound (US) versus
palpation-guided acromioclavicular (AC) joint intra-articular (IA) corticosteroid injection for patients
with osteoarthritis (OA) of the AC joint.
Study Design: Retrospective, compared clinical study.
Setting: University hospital outpatient pain clinic.
Method: We retrospectively reviewed the charts of patients with AC joint degenerative OA who had
undergone US or palpation-guided AC joint IA corticosteroid injection between January 2012 and December
2013 at our outpatient clinic. One hundred consecutive patients identified from chart review met inclusion
criteria. Patients (N = 50) in US guide AC joint IA steroid injection group were administered a mixture of
0.5% lidocaine (1 mL) with triamcinolone (20 mg/mL; 0.5 mL) and radiographic contrast material (0.5 mL)
and patients (N = 50) in palpation-guided AC joint IA steroid injection group were administered a mixture
of 0.5% lidocaine (1 mL) with triamcinolone (20 mg/mL; 0.5 mL) and 0.5 mL of radiographic contrast
material. Results were measured using the Shoulder Pain and Disability Index (SPADI), Verbal Numeric
pain Scale (VNS) at rest (VNSar), under local pressure (VNSlp) ,and the arm adduction test (VNSaat) at the
joint space area before injections and at one, 3, and 6 months after the injections. Successful treatment
occurred when patients obtained significant pain relief (as measured by > 50% improvement in the VNS
score and 20 point improvement in the SPADI) at one, 3, and 6 months after the injections. Univariable
analysis was performed to evaluate the relationship between possible outcome predictors and therapeutic
effect by using a chi-square test. Logistic regression analysis was performed to assess whether injection
method, injection accuracy, patients’ age, gender, and duration of the disease were independent predictors
of successful outcome.
Results: SPADI, VNSaat, VNSlp, and VNSar improved at one, 3, and 6 months after the injections in
both groups. There was a statistically significantly greater improvement in the VNSlp score and SPDAI at
6 months and in the VNSaat score at 3 months and 6 months for US-guided group as compared with
the palpation group. Successful treatment is defined as significant differences found between the groups
or from the 3-month to 6-month outcomes. Multiple logistic regression and univariable analysis showed
that the significant outcome predictors at 6-month follow-up was the injection accuracy.
Limitations: Limitations include the retrospective nature of the study, lack of evaluation of longterm effects , most of the injections were performed in patients with a BMI of less than 30 kg/m2, and
the treatment procedures were conducted by the same physician.
Conclusion: US-guided AC joint IA injection for the treatment of symptomatic AC joint OA resulted in
better pain and functional status improvement than palpation-guided IA injection at the 6-month follow-up.
Key Words: Ultrasound, injection, acromioclavicular joint, steroid