Glenohumeral Injection Using Anatomic Landmark Versus Sonographic Needle Guidance

Abstract

ABSTRACTObjectiveWe hypothesized ultrasound (US) guidance improves outcomes of corticosteroid injection of the painful shoulder.Methods30 patients with symptomatic shoulders due to osteoarthritis were randomized to glenohumeral injection with 3 milliliters of 1% lidocaine and 60 mg of triamcinolone acetonide using the anterior approach with 1) conventional anatomic landmark palpation-guidance or 2) US-guidance. Injection pain (visual analogue pain scale (VAS)), pain at outcome (2 weeks and 6 months), therapeutic duration, time-to-next-injection, and costs were determined.ResultsInjection pain was less with US (VAS: 0.3±0.6 cm) vs. landmark-guidance (VAS: 1.4±2.4 cm, 95% CI of difference: 0.5<1.1<1.7, p=0.05). Pain scores were similar at 2 weeks: US: 2.2±2.4 cm; Landmark: 1.8±2.7 cm, 95% CI of difference: −2.2<−0.4<1.4, p=0.66 and 6 months: US: 5.8±2.8 cm; Landmark: 6.4±2.9 cm, 95% CI of difference: −0.4<0.6< 1.1, p =0.71. Therapeutic duration (US: 3.9±1.5 months; Landmark: 3.0±1.2 months, 95% CI of difference: − 1.4 <−0.9<−0.4, p=0.045) and time-to-next-injection (US: 8.1±3.5 months; Landmark: 5.7±2.9 months, 95% CI of difference: −3.6<−2.4<−1.3, p=0.025) were longer, and fewer injections per year (29% less) were required: US: 1.5±0.2 injections/year; Landmark: 2.1±0.2 injections/year (p<0.037; 95% CI of difference −0.9<−0.6<−0.3). However, cost/patient/year was modestly greater with US (US: $318±89, Landmark: $301±67; p=0.28).ConclusionAnatomic landmark guidance in the short-term is equally effective as US for injection of the osteoarthritic shoulder and modestly less costly, however, US may reduce the need for repetitive injections by prolonging the therapeutic effect and thus time to next injection.IRB StatementThis project was in compliance with the Helsinki Declaration, was approved by the Institutional Review Board (IRB) as ultrasound subset of a syringe safety trial (Human Research Review Committee approval 04-347), and was registered at ClinicalTrials.gov (Clinical Trial Identifier NCT00651625). The subjects gave informed consent to participate prior to all studies and interventions. Patient confidentiality was protected according to the U.S. Health Insurance Portability and Accountability Act (HIPAA) and all data was de-identified.