What is the evidence for ultrasound guided injection for the treatment of shoulder pathology?
AMSTAR Rating
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:
- 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).
- Function: USG injection vs. landmark guided injection (2 studies) – no difference was found.
- 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.
- 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).
