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Positive outcomes with intra-articular glenohumeral injections are independent of accuracy.

Publication ,  Journal Article
Hegedus, EJ; Zavala, J; Kissenberth, M; Cook, C; Cassas, K; Hawkins, R; Tobola, A
Published in: J Shoulder Elbow Surg
September 2010

BACKGROUND: Shoulder pain is a common, costly, and recalcitrant affliction. One treatment for shoulder pain is intra-articular injection of corticosteroid. Clinical opinion is that injection guided by palpation is accurate and effective, and there is some evidence to support a positive effect of injection on pain. However, great controversy exists as to the accuracy of injection by palpation, whether or not accuracy is important, and what the effect is of accuracy on pain. METHODS: We used a blinded, longitudinal observational design of effectiveness in an effort to determine the accuracy of intra-articular injections and the effect of that accuracy on pain and functional outcomes in patients with various shoulder pathologies. RESULTS: Injection accuracy data were captured on 103 patients. Of the 103 blinded injections, 54 received injections that were identified by fluoroscopy as "in" the capsule, whereas 49 were identified as "outside" the capsule; an accuracy rate of 52.4%. In the 4-week follow up, regardless of group assignment or accuracy of the injection, patients improved significantly (P < .01) from pre- to post-injection. Improvement was typically over by 2.5 points in the Numeric Pain Rating Scale (NPRS) categories, over 8 points on the Short-Form McGill Pain Questionnaire (SFMPQ), and over by 13 points on the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH). DISCUSSION: Our accuracy rate was within the range reported in the literature. Improvements in all subjects with regard to pain and self-reported function occurred even in light of a wide variance in subject duration of symptoms, multiple injectors with varied training, a blinded approach to injection, and multiple injection approaches. CONCLUSIONS: The accuracy of the injection does not appear to depend on the experience of the physician and may be irrelevant in treating shoulder pain of multiple origins.

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Published In

J Shoulder Elbow Surg

DOI

EISSN

1532-6500

Publication Date

September 2010

Volume

19

Issue

6

Start / End Page

795 / 801

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surveys and Questionnaires
  • Shoulder Pain
  • Shoulder Joint
  • Reproducibility of Results
  • Range of Motion, Articular
  • Pain Measurement
  • Orthopedics
  • Middle Aged
  • Male
 

Citation

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Hegedus, E. J., Zavala, J., Kissenberth, M., Cook, C., Cassas, K., Hawkins, R., & Tobola, A. (2010). Positive outcomes with intra-articular glenohumeral injections are independent of accuracy. J Shoulder Elbow Surg, 19(6), 795–801. https://doi.org/10.1016/j.jse.2010.03.014
Hegedus, Eric J., John Zavala, Michael Kissenberth, Chad Cook, Kyle Cassas, Richard Hawkins, and Allison Tobola. “Positive outcomes with intra-articular glenohumeral injections are independent of accuracy.J Shoulder Elbow Surg 19, no. 6 (September 2010): 795–801. https://doi.org/10.1016/j.jse.2010.03.014.
Hegedus EJ, Zavala J, Kissenberth M, Cook C, Cassas K, Hawkins R, et al. Positive outcomes with intra-articular glenohumeral injections are independent of accuracy. J Shoulder Elbow Surg. 2010 Sep;19(6):795–801.
Hegedus, Eric J., et al. “Positive outcomes with intra-articular glenohumeral injections are independent of accuracy.J Shoulder Elbow Surg, vol. 19, no. 6, Sept. 2010, pp. 795–801. Pubmed, doi:10.1016/j.jse.2010.03.014.
Hegedus EJ, Zavala J, Kissenberth M, Cook C, Cassas K, Hawkins R, Tobola A. Positive outcomes with intra-articular glenohumeral injections are independent of accuracy. J Shoulder Elbow Surg. 2010 Sep;19(6):795–801.
Journal cover image

Published In

J Shoulder Elbow Surg

DOI

EISSN

1532-6500

Publication Date

September 2010

Volume

19

Issue

6

Start / End Page

795 / 801

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surveys and Questionnaires
  • Shoulder Pain
  • Shoulder Joint
  • Reproducibility of Results
  • Range of Motion, Articular
  • Pain Measurement
  • Orthopedics
  • Middle Aged
  • Male