High volumen infiltration for subacromial shoulder pain
Subacromial injection of high volume versus conventional steroid injection guided by ultrasound in shoulder pain. Randomized controlled trial
Shoulder Impingement Syndrome (SIS) is a condition in which structures of the subacromial space are chronically trapped between the humeral head and the acromion that causes pain and limitations to perform activities of daily living and evidence suggests that this condition is no self-limited, for this there are different alternatives of treatment. Conservative treatment includes physical therapy, non-steroidal anti-inflammatory analgesics (NSAIDs) and subacromial infiltration. Surgical treatment includes shoulder arthroscopy to perform acromioplasty and thus release the subacromial space. The objective of our work was to evaluate the effectiveness of subacromial injection of high volume versus conventional injected volume guided by ultrasound in patients with shoulder impingement syndrome.
Materials And Methods
This is a comparative, prospective, blind, experimental and randomized study. Patients of any gender in a range of 18 to 70 years old, with diagnosis of shoulder impingement syndrome by medical history, physical examination and imaging, informed consent, 3 month history of pain and disability in the shoulder, failure of conservative initial treatment with anti-inflammatory drugs and rehabilitation, and severe pain in the shoulder that did not allow rehabilitation were included. Twenty two patients were divided into two groups, patients in the first group were injected with a high volume (HV) of 40 mL, which included 2 mL of methylprednisolone, 8 mL of lidocaine, 10 mL of 7.5% ropivacaina and 20 mL of physiological solution; patients in the second group were injected with a conventional volume (CV) of 5 mL, which included 2 mL of methylprednisolone, 2 mL of 7.5% ropivacaina and 1 mL of lidocaine. Both procedures were ultrasound-guided performed.
All participants were evaluated pre and post injection with questionnaires to assess pain, function and disability. The questionnaires include shoulder pain and disability index (SPADI), the simple shoulder test (SST), and the visual analogue scale (VAS). These questionnaires were answered in the following way:
- Pre Injection
- 10 min post injection
- Within 7 days
- Within 30 days
- At 3 months
Both groups of patients were homogeneous for baseline SPADI, SST and VAS scores. Both injection techniques showed significant improvements in SPADI (HV, p<0.001; CV, p<0.01), SST (HV, p<0.001; CV, p<0.05) and VAS (HV, p<0.01; CV, p<0.01) scores at 1 month compared to baseline values. Only the CV group showed a significant improvement in SPADI (p<0.05) and SST (p<0.05) scores at 3 months. There were no significant differences in functional and pain scores SPADI, SST and VAS scores between groups at any of the follow-up time points.
At three months evaluation, similar results in function and pain, were observed between conventional infiltration and high volume infiltration in patients with Shoulder Impingement Syndrome