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Effects of Ultrasound-Guided Peritendinous and Intrabursal Corticosteroid Injections on Shoulder Tendon Elasticity: A Post Hoc Analysis of a Randomized Controlled Trial

  • Po-Cheng Hsu
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
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  • Ke-Vin Chang
    Correspondence
    Corresponding author Ke-Vin Chang, MD, PhD, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei‑Hu Branch, No. 87, Neijiang Street, Wanhua District, Taipei City 108, Taiwan.
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan

    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, Bei-Hu Branch, Taipei, Taiwan

    National Taiwan University College of Medicine, Taipei, Taiwan
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  • Jia-Chi Wang
    Affiliations
    Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan

    School of Medicine, National Yang-Ming University, 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:December 15, 2020DOI:https://doi.org/10.1016/j.apmr.2020.11.011

      Abstract

      Objectives

      The study aimed to investigate whether the shoulder tendons changed their elasticity after ultrasound-guided peritendinous or intrabursal corticosteroid injections.

      Design

      Post hoc secondary analysis of a double-blinded, randomized controlled study with 3 months of follow-up.

      Setting

      Outpatient rehabilitation clinic.

      Participants

      Patients with subacromial impingement syndrome (N=60).

      Interventions

      Patients with unilateral shoulder pain were randomly assigned to receive standard ultrasound-guided subacromial or dual-target corticosteroid injections. The supraspinatus tendons were exposed to 40 mg triamcinolone acetonide in the formal group, whereas the long head of the biceps brachii tendons (LHBT) and supraspinatus tendons were individually infiltrated by 20 mg triamcinolone acetonide in the latter group. Patients’ bilateral shoulders were divided into group 1 (n=30, receiving standard subacromial injections), group 2 (n=30, receiving dual-target injections), and group 3 (n=60, without injections).

      Main Outcome Measures

      Strain ratio of LHBT and supraspinatus tendons using ultrasound elastography.

      Results

      The repeated-measures analysis of variance revealed no intragroup difference of the strain ratio of the LHBT (P=.412 for group 1, P=.936 for group 2, P=.131 for group 3) and supraspinatus tendon (P=.309 for group 1, P=.067 for group 2, P=.860 for group 3) across the 3 time points. Treating group 3 as the reference, the linear mixed model revealed no significant changes in tendon elasticity after either the standard subacromial injection (P=.205 for the LHBT and P=.529 for the supraspinatus tendon) or the dual-target injection (P=.961 for the LHBT and P=.831 for the supraspinatus tendon).

      Conclusions

      Elasticity of the LHBT and supraspinatus tendons is unlikely to change after a single dose of peritendinous or intrabursal corticosteroid injections. Future studies with a shorter follow-up interval are needed to validate whether corticosteroid injections can cause transient changes of the tendon’s elasticity.

      Keywords

      List of abbreviations:

      ANOVA (analysis of variance), LHBT (long head of the biceps brachii tendons), ROI (region of interest), US (ultrasound)
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