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Static and Dynamic Shoulder Imaging to Predict Initial Effectiveness and Recurrence After Ultrasound-Guided Subacromial Corticosteroid Injections

  • Ke-Vin Chang
    Correspondence
    Corresponding author Ke-Vin Chang, MD, PhD, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Number 87, Neijiang Street, Wanhua District, Taipei City 108, Taiwan.
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch and National Taiwan University College of Medicine, Taipei, Taiwan
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  • Wei-Ting Wu
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch and National Taiwan University College of Medicine, Taipei, Taiwan
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  • Der-Sheng Han
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch and National Taiwan University College of Medicine, Taipei, Taiwan
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  • Levent Özçakar
    Affiliations
    Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Published:February 25, 2017DOI:https://doi.org/10.1016/j.apmr.2017.01.022

      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.

      Keywords

      List of abbreviations:

      CI (confidence interval), HR (hazard ratio), OR (odds ratio), US (ultrasound)
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