Naredo Esperanza, Cabero Felix, Beneyto Pedro, Cruz Ana, Mondéjar Belén, Uson Jacqueline, Palop Mercedes J, Crespo Manuel
Department of Rheumatology, the Research Unit, and the Epidemiology Unit, Severo Ochoa Hospital, Madrid, Spain.
J Rheumatol. 2004 Feb;31(2):308-14.
Local corticosteroid injections, commonly accepted by rheumatologists to be effective treating painful shoulder, have shown controversial results. High frequency ultrasonography is an accurate and safe imaging modality for guiding musculoskeletal injections. We prospectively compared the short term response to randomized blind injection versus sonographic-guided injection of local corticosteroid in patients with painful shoulder.
We studied 41 consecutive patients with painful shoulder. Patients with previous trauma or chronic inflammatory arthritis were excluded. No patient had received previous physiotherapy or local steroid injection in the shoulder. Patients were randomized to receive either a blind subacromial injection of 20 mg triamcinolone (Group 1, n = 20) or a sonographic guided injection of 20 mg triamcinolone (Group 2, n = 21) by the same rheumatologist blinded to the clinical evaluation. In both groups we recorded shoulder abnormalities and the location of the steroid postinjection by ultrasound. Each patient was clinically assessed within 5 days before injection and 6 weeks after injection by another rheumatologist without knowledge of the injection technique performed. Clinical assessment included demographic and clinical data, a visual analog scale (VAS) for pain (0-100), the Shoulder Function Assessment (SFA) scale (0-70), and postinjection adverse effects. No patient received physical therapy during the followup period. Initially, demographic, clinical, and ultrasonographic findings in both groups showed no significant differences.
Six weeks after injection, the VAS and the SFA score showed a significantly greater improvement in Group 2 compared with Group 1 (mean VAS score change 34.9 for Group 2 vs 7.1 for Group 1, p < 0.001; and mean SFA score change 15 for Group 2 vs 5.6 for Group 1, p = 0.012). One patient in Group 1 reported mild postinjection adverse effects.
We suggest that sonographic-guided corticosteroid injections should be indicated, at least, in patients with poor response to previous blind injection to ensure accurate medication placement in order to improve therapeutic effectiveness.
局部注射皮质类固醇激素治疗肩部疼痛，虽被风湿病学家普遍认为有效，但结果存在争议。高频超声是一种准确且安全的成像方式，可用于指导肌肉骨骼注射。我们前瞻性地比较了随机盲注与超声引导下局部注射皮质类固醇激素治疗肩部疼痛患者的短期反应。
我们研究了41例连续的肩部疼痛患者。排除既往有创伤或慢性炎症性关节炎的患者。所有患者此前均未接受过肩部物理治疗或局部类固醇注射。患者被随机分为两组，由同一位对临床评估不知情的风湿病学家进行操作，一组接受20毫克曲安奈德的盲法肩峰下注射（第1组，n = 20），另一组接受超声引导下20毫克曲安奈德的注射（第2组，n = 21）。两组均通过超声记录肩部异常情况及注射后类固醇的位置。每位患者在注射前5天和注射后6周由另一位不了解注射技术的风湿病学家进行临床评估。临床评估包括人口统计学和临床数据、疼痛视觉模拟量表（VAS，0 - 100）、肩部功能评估（SFA）量表（0 - 70）以及注射后不良反应。随访期间所有患者均未接受物理治疗。最初，两组的人口统计学、临床和超声检查结果无显著差异。
注射6周后，第2组的VAS和SFA评分改善程度明显高于第1组（第2组VAS评分平均变化34.9，第1组为7.1，p < 0.001；第2组SFA评分平均变化15，第1组为5.6，p = 0.012）。第1组有1例患者报告了轻度注射后不良反应。
我们建议，至少对于既往盲注效果不佳的患者，应采用超声引导下皮质类固醇注射，以确保药物准确注射到位，从而提高治疗效果。
