AB0790 ULTRASOUND-GUIDED VERSUS ANATOMICAL LANDMARK INJECTION OF THE SHOULDER JOINT; A RETROSPECTIVE STUDY
Authors: A. Radwan, A. Elsaman
Journal: Annals of the Rheumatic Diseases (2021)

Background: Ultrasound is a widely used tool for diagnostic and interventional purposes for a myriad of musculoskeletal conditions. The question about the value of ultrasound-guided injection over blind injection is debatable [1, 2]. Objectives: To test the value of ultrasound-guided injection versus blind subacromial-subdeltoid bursitis, subcoracoid bursitis, long head of biceps synovial sheath, and intra-articular shoulder injection. Methods: We included 168 participants (66 subacromial-subdeltoid bursitis, 52 subcoracoid, 10 with long head of biceps tenosynovitis 38 had adhesive capsulitis and performed intra-articular shoulder injection) half of them were injected by blind technique and the other half were injected under ultrasound guidance. All of them were diagnosed by ultrasound. All were injected with methylprednisolone acetate 40 mg (Solumedrol, Pfizer) + lidocaine hydrochloride 1% (Xylocaine Astra Zeneca), 2 ml. SPADI score and range of motion were performed before injection and immediately after the injection, after 2 weeks, and after 4 weeks. Further, complications were recorded immediately after the injection, after 2 weeks, and after 4 weeks. Results: The mean age of the study group was around 35.5 years, with no significant difference between the two groups, with slightly male predominance (60.7%). The mean SPADI score was similar between the groups before injection, but the improvement was higher among ultrasound-guided group compared to anatomical landmark-guided group, as showed by the significant difference between the two groups regarding SPADI scores at 2 and 4 weeks post-injection. Regarding the improvement of the range of motion, the ultrasound-guided group showed significantly better improvement compared to the anatomical landmark-guided one all over the 4-week course of follow up. The complication rate was slightly higher among the landmark-guided group, but with non-significant difference (Table 1). The difference between the two groups was highest among adhesive capsulitis cases with intra-articular injection. Conclusion: Ultrasound-guided injections showed better outcomes for all the 4 injections, especially for intra-articular injection, in addition, it showed a significantly less complications than blind injection. References: [1]Elsaman A, Hamed A, Radwan A. Ultrasound-guided epidural block in axial spondyloarthritis patients with limited spine mobility: a randomized controlled trial. The Korean Journal of Pain 2021; 34: 114. [2]Elsaman AM, Mostafa ES, Radwan AR. Ankle Evaluation in Active Rheumatoid Arthritis by Ultrasound: A Cross-Sectional Study. Ultrasound in medicine &amp; biology 2017; 43: 2806-13. Table 1. Comparison between the two groups Ultrasound – guided (n=84) Anatomic landmark – guided (n=84) P value Age 35.4±9.5 36.0±9.5 0.643 Sex Male 49(58.3%) 53(63.1%) 0.527 Female 35(41.7%) 31(36.9%) Site Subacromial-subdeltoid bursitis 33(39.3%) 33(39.3%) 0.998 Subcoracoid 26(31%) 27(32.1%) Long head of biceps tenosynovitis 5(6%) 5(6%) Adhesive capsulitis 20(23.8%) 19(22.6%) SPADI score Pre-injection 55.8±9.4 54.7±10.1 0.466 Immediately post-injection 48.6±8.2 51.2±8.9 0.051 2 weeks post-injection 44.9±10.1 49.6±9.3 0.002 4 weeks post-injection 42.4±9.7 47.6±7.8 0.001 Range of motion improvement (percent) Immediately post-injection 33.6±9.7% 29.4±11.2% 0.010 2 weeks post-injection 37.2±8.5% 32.7±9.9% 0.002 4 weeks post-injection 40.1±7.3% 33.6±8.3% &lt;0.001 Complications Pain 12(14.3%) 19(22.6%) 0.164 Bleeding 3(3.6%) 8(9.5%) 0.119 Vasovagal attack 4(4.8%) 3(3.6%) 0.699 Disclosure of Interests: None declared