Saeed Aamir, Khan Mumtaz, Morrissey Siobhan, Kane David, Fraser Alexander Duncan
Department of Rheumatology, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland,
Rheumatol Int. 2014 Apr;34(4):503-9. doi: 10.1007/s00296-013-2892-z. Epub 2013 Nov 5.
The use of musculoskeletal ultrasonography (MSUS) in guiding subdeltoid injection has been shown to improve outcome up to 6 weeks in a few small studies. A recent meta-analysis identified the need for further studies with longer-term outcome and larger sample size. This randomized prospective study assessed whether clinic-based MSUS can significantly improve diagnostic accuracy in shoulder pain and whether MSUS-guided shoulder injection results in improved long-term outcomes. One hundred consecutive patients with 125 painful shoulders were recruited. Patients were randomized to receive either sonographic assessment with consequent palpation-guided injection (Group 1, n = 66) or sonographic assessment with a MSUS-guided injection of 40 mg of methylprednisolone acetate (Group 2, n = 59). A blinded rheumatologist (ADF) performed clinical assessments at baseline, 6 and 12 weeks including shoulder function tests (SFTs) (Hawkins-Kennedy test, supraspinatus tendon tenderness), physician global assessment (PGA) and patient visual analogue scores (VAS) for pain (0-10). Eighty patients with 90 symptomatic shoulders completed 12-week follow-up. Twenty patients, 11 (20 shoulders) from the palpation-guided group and 9 (15 shoulders) from the MSUS-guided group, were excluded at 6 weeks either due to requirement for repeat injection or due to surgical referral. Mean age for patients was 57.7 years, and 65 % patients were female; mean shoulder pain duration was 18 weeks (range 14-22 weeks). SFTs, patient VAS and PGA scores for pain improved significantly from baseline in both groups with significantly greater improvements in the MSUS-guided group (44 shoulders) compared to the palpation-guided group (46 shoulders) in all parameters at 6 (p < 0.01) and 12 weeks (p < 0.05). The use of MSUS in guiding subdeltoid injection has been shown to improve outcome up to 6 weeks in a few small studies. A recent meta-analysis identified the need for further studies with longer-term outcome and larger sample size.
在一些小型研究中，已表明使用肌肉骨骼超声检查（MSUS）引导三角肌下注射可在长达6周的时间内改善治疗效果。最近的一项荟萃分析指出，需要开展更多关于长期治疗效果及更大样本量的研究。这项随机前瞻性研究评估了基于临床的MSUS是否能显著提高肩部疼痛的诊断准确性，以及MSUS引导下的肩部注射是否能带来更好的长期治疗效果。研究招募了100例连续患者，共125个疼痛肩部。患者被随机分为两组，一组接受超声评估并随后进行触诊引导注射（第1组，n = 66），另一组接受超声评估并在MSUS引导下注射40mg醋酸甲泼尼龙（第2组，n = 59）。一位盲法风湿病学家（ADF）在基线、6周和12周时进行临床评估，包括肩部功能测试（SFTs）（霍金斯 - 肯尼迪试验、冈上肌腱压痛）、医生整体评估（PGA）以及患者疼痛视觉模拟评分（VAS）（0 - 10分）。80例患者共90个有症状的肩部完成了12周的随访。20例患者，其中触诊引导组11例（20个肩部），MSUS引导组9例（15个肩部），在6周时因需要重复注射或手术转诊而被排除。患者的平均年龄为57.7岁，65%为女性；平均肩部疼痛持续时间为18周（范围14 - 22周）。两组的SFTs、患者VAS和PGA疼痛评分均较基线有显著改善，在6周（p < 0.01）和12周（p < 0.05）时，MSUS引导组（44个肩部）在所有参数上的改善均显著大于触诊引导组（46个肩部）。在一些小型研究中，已表明使用MSUS引导三角肌下注射可在长达6周的时间内改善治疗效果。最近的一项荟萃分析指出，需要开展更多关于长期治疗效果及更大样本量的研究。
