Static and Dynamic Shoulder Imaging to Predict Initial Effectiveness and Recurrence After Ultrasound-Guided Subacromial Corticosteroid Injections
Journal
Archives of Physical Medicine and Rehabilitation
Journal Volume
98
Journal Issue
10
Pages
1984-1994
Date Issued
2017
Author(s)
Abstract
Objective To explore factors contributing to initial effectiveness and recurrence after ultrasound (US)-guided subacromial corticosteroid injections by assessing clinical measurements and static and dynamic shoulder US images. Design Retrospective cohort study. Setting Rehabilitation outpatient clinic. Participants Adults with shoulder pain referred for injection therapy (N=164). Intervention US-guided subacromial corticosteroid injection. Main Outcome Measures The association of initial effectiveness (defined as >50% decrease in any of the 3 pain subdomains after the first injection) and recurrent shoulder pain that required repeated intervention with record-based clinical measurements and static/dynamic shoulder US. Results This study included 164 patients, 106 of whom were responsive to a first injection. Among the 106 participants, 42 received a second injection because of recurrent shoulder pain. By using the multivariate logistic regression analysis, initial effectiveness was positively associated with right handedness, grade 2 subacromial impingement during the dynamic US examination, and bicipital groove tenderness. However, these patients had a negative association with subdeltoid bursitis, grade 3 subacromial impingement, and shoulder stiffness. Subdeltoid bursitis and a positive painful arc test were predictors of recurrent shoulder pain that necessitated a repeated injection in the Cox proportional hazards model. Conclusions The initial effectiveness and recurrence after US-guided subacromial corticosteroid injection were associated with certain clinical measurements and static and dynamic shoulder US, which should be carefully evaluated (and can be used) to guide the best treatment outcomes. ? 2017 American Congress of Rehabilitation Medicine
SDGs
Other Subjects
corticosteroid; lidocaine; triamcinolone acetonide; glucocorticoid; adult; Article; bursitis; clinical assessment; cohort analysis; controlled study; drug administration; drug efficacy; female; frozen shoulder; human; interventional ultrasonography; major clinical study; male; multivariate logistic regression analysis; outpatient department; patient referral; prediction; recurrent disease; rehabilitation center; repeat procedure; retrospective study; right handedness; shoulder impingement syndrome; shoulder pain; subacromial drug administration; treatment response; bursitis; complication; diagnostic imaging; hemispheric dominance; interventional ultrasonography; intraarticular drug administration; middle aged; multivariate analysis; recurrent disease; retreatment; shoulder; shoulder pain; Bursitis; Cohort Studies; Female; Functional Laterality; Glucocorticoids; Humans; Injections, Intra-Articular; Male; Middle Aged; Multivariate Analysis; Recurrence; Retreatment; Retrospective Studies; Shoulder Impingement Syndrome; Shoulder Joint; Shoulder Pain; Ultrasonography, Interventional
Publisher
W.B. Saunders
Type
journal article