Injection of the subacromial bursa in patients with rotator cuff syndrome a prospective, randomized study comparing the effectiveness of different routes

A prospective, randomized study comparing the effectiveness of different routes

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Abstract

Background: Rotator cuff syndrome is often treated with subacromial injection of corticosteroid and local anesthetic. It has not been established if the common injection routes of the bursa are equally accurate. Methods: We conducted a prospective clinical trial involving seventy-five shoulders in seventy-five patients who were randomly assigned to receive a subacromial injection through an anterior, lateral, or posterior route with respect to the acromion. An experienced physician performed the injections, which contained radiopaque contrast medium, corticosteroid, and local anesthetic. After the injection, a musculoskeletal radiologist, blinded to the injection route, interpreted all of the radiographs. Results: The rate of accuracy varied with the route of injection, with a rate of 56% for the posterior route, 84% for the anterior route, and 92% for the lateral route (p = 0.006; chi-square test). The accuracy of injection through the posterior route was significantly lower than that through either the anterior or the lateral route (p < 0.05 for both comparisons; Poisson regression). In addition, the accuracy of injection was significantly lower in females than in males (p < 0.006; chisquare test). Among males, no differences between the routes were noted (with accuracy rates of 89% for the posterior route, 92% for the anterior route, and 93% for the lateral route). Among females, however, the accuracy of injection was lower for the posterior route than for either the anterior or the lateral route (with accuracy rates of 38% for the posterior route, 77% for the anterior route, and 91% for the lateral route) (p < 0.05). Conclusions: The anterior and lateral routes of subacromial bursal injection were more accurate than the posterior route. The accuracy of subacromial bursal injection was significantly different between males and females, mainly because of a lower accuracy of bursal injection with use of the posterior route in females. The present study suggests that the posterior route is the least accurate method for injection of the subacromial bursa in females. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)1442-1447
Number of pages6
JournalJournal of Bone and Joint Surgery - Series A
Volume94
Issue number16
DOIs
StatePublished - Aug 15 2012

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Rotator Cuff
Prospective Studies
Injections
Local Anesthetics
Contrast Media
Adrenal Cortex Hormones
Acromion
Chi-Square Distribution

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

@article{172b93075d0f4b55a1296ea2d8a8654a,
title = "Injection of the subacromial bursa in patients with rotator cuff syndrome a prospective, randomized study comparing the effectiveness of different routes: A prospective, randomized study comparing the effectiveness of different routes",
abstract = "Background: Rotator cuff syndrome is often treated with subacromial injection of corticosteroid and local anesthetic. It has not been established if the common injection routes of the bursa are equally accurate. Methods: We conducted a prospective clinical trial involving seventy-five shoulders in seventy-five patients who were randomly assigned to receive a subacromial injection through an anterior, lateral, or posterior route with respect to the acromion. An experienced physician performed the injections, which contained radiopaque contrast medium, corticosteroid, and local anesthetic. After the injection, a musculoskeletal radiologist, blinded to the injection route, interpreted all of the radiographs. Results: The rate of accuracy varied with the route of injection, with a rate of 56{\%} for the posterior route, 84{\%} for the anterior route, and 92{\%} for the lateral route (p = 0.006; chi-square test). The accuracy of injection through the posterior route was significantly lower than that through either the anterior or the lateral route (p < 0.05 for both comparisons; Poisson regression). In addition, the accuracy of injection was significantly lower in females than in males (p < 0.006; chisquare test). Among males, no differences between the routes were noted (with accuracy rates of 89{\%} for the posterior route, 92{\%} for the anterior route, and 93{\%} for the lateral route). Among females, however, the accuracy of injection was lower for the posterior route than for either the anterior or the lateral route (with accuracy rates of 38{\%} for the posterior route, 77{\%} for the anterior route, and 91{\%} for the lateral route) (p < 0.05). Conclusions: The anterior and lateral routes of subacromial bursal injection were more accurate than the posterior route. The accuracy of subacromial bursal injection was significantly different between males and females, mainly because of a lower accuracy of bursal injection with use of the posterior route in females. The present study suggests that the posterior route is the least accurate method for injection of the subacromial bursa in females. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.",
author = "Marder, {Richard A} and Kim, {Sunny H} and Labson, {Jerry D.} and Hunter, {John C}",
year = "2012",
month = "8",
day = "15",
doi = "10.2106/JBJS.K.00534",
language = "English (US)",
volume = "94",
pages = "1442--1447",
journal = "Journal of Bone and Joint Surgery - American Volume",
issn = "0021-9355",
publisher = "Journal of Bone and Joint Surgery Inc.",
number = "16",

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T1 - Injection of the subacromial bursa in patients with rotator cuff syndrome a prospective, randomized study comparing the effectiveness of different routes

T2 - A prospective, randomized study comparing the effectiveness of different routes

AU - Marder, Richard A

AU - Kim, Sunny H

AU - Labson, Jerry D.

AU - Hunter, John C

PY - 2012/8/15

Y1 - 2012/8/15

N2 - Background: Rotator cuff syndrome is often treated with subacromial injection of corticosteroid and local anesthetic. It has not been established if the common injection routes of the bursa are equally accurate. Methods: We conducted a prospective clinical trial involving seventy-five shoulders in seventy-five patients who were randomly assigned to receive a subacromial injection through an anterior, lateral, or posterior route with respect to the acromion. An experienced physician performed the injections, which contained radiopaque contrast medium, corticosteroid, and local anesthetic. After the injection, a musculoskeletal radiologist, blinded to the injection route, interpreted all of the radiographs. Results: The rate of accuracy varied with the route of injection, with a rate of 56% for the posterior route, 84% for the anterior route, and 92% for the lateral route (p = 0.006; chi-square test). The accuracy of injection through the posterior route was significantly lower than that through either the anterior or the lateral route (p < 0.05 for both comparisons; Poisson regression). In addition, the accuracy of injection was significantly lower in females than in males (p < 0.006; chisquare test). Among males, no differences between the routes were noted (with accuracy rates of 89% for the posterior route, 92% for the anterior route, and 93% for the lateral route). Among females, however, the accuracy of injection was lower for the posterior route than for either the anterior or the lateral route (with accuracy rates of 38% for the posterior route, 77% for the anterior route, and 91% for the lateral route) (p < 0.05). Conclusions: The anterior and lateral routes of subacromial bursal injection were more accurate than the posterior route. The accuracy of subacromial bursal injection was significantly different between males and females, mainly because of a lower accuracy of bursal injection with use of the posterior route in females. The present study suggests that the posterior route is the least accurate method for injection of the subacromial bursa in females. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

AB - Background: Rotator cuff syndrome is often treated with subacromial injection of corticosteroid and local anesthetic. It has not been established if the common injection routes of the bursa are equally accurate. Methods: We conducted a prospective clinical trial involving seventy-five shoulders in seventy-five patients who were randomly assigned to receive a subacromial injection through an anterior, lateral, or posterior route with respect to the acromion. An experienced physician performed the injections, which contained radiopaque contrast medium, corticosteroid, and local anesthetic. After the injection, a musculoskeletal radiologist, blinded to the injection route, interpreted all of the radiographs. Results: The rate of accuracy varied with the route of injection, with a rate of 56% for the posterior route, 84% for the anterior route, and 92% for the lateral route (p = 0.006; chi-square test). The accuracy of injection through the posterior route was significantly lower than that through either the anterior or the lateral route (p < 0.05 for both comparisons; Poisson regression). In addition, the accuracy of injection was significantly lower in females than in males (p < 0.006; chisquare test). Among males, no differences between the routes were noted (with accuracy rates of 89% for the posterior route, 92% for the anterior route, and 93% for the lateral route). Among females, however, the accuracy of injection was lower for the posterior route than for either the anterior or the lateral route (with accuracy rates of 38% for the posterior route, 77% for the anterior route, and 91% for the lateral route) (p < 0.05). Conclusions: The anterior and lateral routes of subacromial bursal injection were more accurate than the posterior route. The accuracy of subacromial bursal injection was significantly different between males and females, mainly because of a lower accuracy of bursal injection with use of the posterior route in females. The present study suggests that the posterior route is the least accurate method for injection of the subacromial bursa in females. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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