Purpose
Sub-acromial bursal (SAB) injection of local anaesthetic and corticosteroid is a well-established treatment of patients with shoulder pain.
The efficacy of the intervention has been shown to be of benefit although the numerous studies assessing this are of varied quality (1).
There is evidence to suggest that the use of ultrasound guidance offers a significantly greater clinical improvement over blind SAB injections in adults with shoulder pain (2).
With the correct technique the injectate can be accurately and safely adminstered into the subacromial bursa (Fig....
Methods and Materials
We prospectively studied all patients with shoulder complaints who had a SAB injection in our centre from June to November 2014. Patients with verbal communication difficulties were excluded.
Patients who subsequently underwent surgery in the period 12 months after injection were excluded.
Physiotherapy was not seen as a factor for exclusion.
We used the Shoulder Pain and Disability Index (SPADI) questionnaire (3) at first presentation,
at 6 weeks and at 12 months to assess pain,
disability and both combined.
In the SPADI questionnaire the patient...
Results
The results are presented below:
Patient demographics and Origin of referral
Mean age
54.5 years
(min 26 years to max 91 years)
Females : Males
220 : 174
(56% : 44%)
Referred from
General Practitioner
303 (76.9%)
Extended Scope Practitioner
37 (9.4%)
Shoulder surgeon
27 (6.9%)
Rheumatologist
6 (1.5%)
Other
21 (5.3%)
Diagnosis on Ultrasound
Number
Percentage
Sub-acromial bursitis
26
6.6%
Sub-acromial bursitis and impingement
138
35.0%
Tendinopathy
26
6.6%
Sub-acromial bursitis +/- impingement and associated tendinopathy
124
31.5%
Tendon tear - isolated or in...
Conclusion
The majority of the referrals for SAB injection were from primary care,
in patients with undiagnosed shoulder pain.
There were more female (56%) than male (44%) patients.
The most common diagnosis was subacromial bursitis and impingement,
35.0% of the cohort,
although this was closely followed by subacromial bursitis with tendinopathy,
with or without impingement.
Tendon tears accounted for a smaller proportion (12.7%),
while adhesive capsulitits accounted for 3.6%.
At 6 weeks a large proportion (64%) of patients had a significant improvement in their overall pain...
References
1.
Buchbinder R et al.
2003.
Corticosteroid injections for shoulder pain. Cochrane Database of Systematic Reviews ,
Issue 1.
Art.
No.: CD004016.
DOI: 10.1002/14651858.CD004016.
2.
Wu et al.
Ultrasound-guided versus blind subacromial-subdeltoid bursa injection in adult patients with shoulder pain.
Semin Arthritis Rheum.
2015 Dec;45(3):374-8.
3.
Roach KE et al.
(1991) Development of a shoulder pain and disability index.
Arthritis Care Res 4(4) 143-9.
4.
Roy JS et al.Measuring shoulder function: A systematic review of four questionnaires.
Arthritis & Rheumatism (61)623–632.