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What is the evidence for ultrasound guided injection for the treatment of shoulder pathology?

Summary

Patient Population:

Adult population; varying duration of symptoms.

Intervention:

Triamcinolone (3 studies), betamethasone (2 studies), depo-medrone (1 study).

Comparison:

6 controlled studies were identified for inclusion in the present review (n=307; 142 participants received landmark guided injection, 165 received ultrasound-guided injection).  The authors refer to 2 previous reviews (Soh et al. 2011 & Gilliland et al. 2011) – the most recent of which included only 2 trials (both of which also appear in this review).  Two trials in this review are RCTs.  Overall, methodological quality is described as variable.

Outcome:

  1. Pain: USG injection vs. landmark guided injection (3 studies) – significant difference in favour of USG at 6 weeks (SMD=1.03; 95%CI 0.12 to 1.93; p=0.03).
  2. Function: USG injection vs. landmark guided injection (2 studies) – no difference was found.
  3. ROM: USG injection vs. landmark guided injection – significant difference in favour of USG at 6 weeks (SMD = 2.81; 95% CI 0.67 to 4.95; p=0.01). However, the authors suggest that in terms of degrees of movement this amount of change is not of clinical significance.
  4. The authors conclude that there may be a small benefit associated with ultrasound guided injection in the short term, but none of the studies seems to support the notion that improved accuracy is associated with substantially improved benefit – particularly over the long-term (no long-term follow-up was performed in any of the studies).

Outcomes Assessed

  • Benefit
  • Harm
  • Inconclusive

USG Injection vs. Landmark Guided Injection

Pain

Function

ROM

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