2015 ISAKOS Biennial Congress ePoster #2205

Accuracy of the Biceps Tendon Sheath Injection: Ultrasound-Guided or Unguided Injection? A Randomized Controlled Trial

Tomohisa Hashiuchi, MD, PhD, Nara, Nara JAPAN
Goro Sakurai, MD, PhD, Nara JAPAN
Yoshinori Takakura, Kashihara, Nara JAPAN
Tsukasa Kumai, MD, Nara JAPAN
Yasuhito Tanaka, Prof., Kashihara, Nara JAPAN

Nishinara Central Hospital, Nara, Kinki, JAPAN

FDA Status Cleared

Summary: Injection into the tendon sheath of the long head of the biceps brachii can be more accurately performed using ultrasound guidance than unguided method.

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Abstract:

Background

Patients often localize pain in the anterior shoulder however pain localization is by the patient does not necessarily correlate to the location of disease.

In clinical practice, unguided shoulder injections are common. The accuracy of unguided biceps tendon sheath injections has not been studied. Patient management may be aided by the knowledge of injection accuracy. The purpose of this study was to compare accuracy of ultrasound guided biceps tendon sheath injection and unguided injection.

MATERIALS & METHODS
Thirty subjects with reported anterior shoulder pain and in whom tenosynovitis and/or tendinitis of the biceps tendon was the primary diagnosis formed the study group. Shoulders were randomly allocated into ultrasound-guided and unguided injection groups. CAT scan imaging was immediately performed after injecting a contrast agent into the biceps tendon sheath. The locations of contrast depicted on CAT scan were classified into the three types : only within tendon sheath (type 1), inside the tendon, tendon sheath and surrounding area (type 2), and only the area outside the tendon sheath (type 3).

Results

Ultrasound-guided injections resulted in 86.7% type 1 and 13.3% type 2 locations. Unguided injections resulted in 26.7% type 1, 40.0% type 2, and 33.3% type 3 locations. The difference for each location type was significantly different (p< 0.05).

Conclusion

Injection into the tendon sheath of the long head of the biceps brachii can be more accurately performed using ultrasound guidance than unguided method.