Ramappa Arun, Walley Kempland C, Herder Lindsay M, Iyer Sravisht, Zurakowski David, Hall Amber, DeAngelis Joseph P
Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
Am J Orthop (Belle Mead NJ). 2017 Jul/Aug;46(4):E257-E262.
Subacromial impingement syndrome (SIS) is the most common cause of shoulder pain. Treatment options for SIS include conservative modalities such as use of nonsteroidal anti-inflammatory drugs, physical therapy, and subacromial corticosteroid injections (CSIs). Although studies have found improvement in pain, function, and range of motion after CSI, the effect of injection route (anterior or posterior) on shoulder pain in patients with SIS has not been investigated. In the study reported here, patients were randomly assigned to 2 treatment groups: anterior CSI and posterior CSI. Pain was assessed with a visual analog scale (VAS) and function with the Single Assessment Numeric Evaluation (SANE). Patients were evaluated before injection (baseline) and 1, 3, and 6 months after injection. Of the 55 patients enrolled, 25 received anterior CSI and 30 received posterior CSI. The 2 groups showed no significant difference in VAS pain at baseline or 1, 3, or 6 months after injection. SANE scores were statistically different at 3 months. Each group had significantly less pain and better function 1, 3, and 6 months after injection than at baseline. Age, sex, and body mass index did not significantly affect the efficacy of anterior or posterior CSIs. In patients with SIS, subacromial CSI reduces pain and improves function for up to 6 months. These effects are no different for anterior and posterior injection routes. As a result, clinicians should rely on their clinical acumen when selecting injection routes, as anterior and posterior are both beneficial.
肩峰下撞击综合征（SIS）是肩部疼痛最常见的原因。SIS的治疗选择包括保守治疗方法，如使用非甾体类抗炎药、物理治疗和肩峰下皮质类固醇注射（CSI）。尽管研究发现CSI后疼痛、功能和活动范围有所改善，但注射途径（前侧或后侧）对SIS患者肩部疼痛的影响尚未得到研究。在本报告的研究中，患者被随机分为2个治疗组：前侧CSI组和后侧CSI组。使用视觉模拟量表（VAS）评估疼痛，使用单一评估数字评定法（SANE）评估功能。在注射前（基线）以及注射后1、3和6个月对患者进行评估。在纳入的55例患者中，25例接受前侧CSI，30例接受后侧CSI。两组在基线时或注射后1、3或6个月的VAS疼痛评分无显著差异。SANE评分在3个月时有统计学差异。每组在注射后1、3和6个月时的疼痛均明显减轻，功能均明显改善，均优于基线时。年龄、性别和体重指数对前侧或后侧CSI的疗效无显著影响。对于SIS患者，肩峰下CSI可减轻疼痛并改善功能长达6个月。前侧和后侧注射途径的效果无差异。因此，临床医生在选择注射途径时应依靠其临床敏锐度，因为前侧和后侧注射途径均有益。
