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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 25, 2017
Footnotes
Supported by the National Science Council (grant no. 104-2314-B-002-022-MY2) and National Taiwan University Hospital, Bei-Hu Branch.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
