Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; National Taiwan University College of Medicine, Taipei, Taiwan.
Arch Phys Med Rehabil. 2021 May;102(5):905-913. doi: 10.1016/j.apmr.2020.11.011. Epub 2020 Dec 15.
The study aimed to investigate whether the shoulder tendons changed their elasticity after ultrasound-guided peritendinous or intrabursal corticosteroid injections.
Post hoc secondary analysis of a double-blinded, randomized controlled study with 3 months of follow-up.
Outpatient rehabilitation clinic.
Patients with subacromial impingement syndrome (N=60).
Patients with unilateral shoulder pain were randomly assigned to receive standard ultrasound-guided subacromial or dual-target corticosteroid injections. The supraspinatus tendons were exposed to 40 mg triamcinolone acetonide in the formal group, whereas the long head of the biceps brachii tendons (LHBT) and supraspinatus tendons were individually infiltrated by 20 mg triamcinolone acetonide in the latter group. Patients' bilateral shoulders were divided into group 1 (n=30, receiving standard subacromial injections), group 2 (n=30, receiving dual-target injections), and group 3 (n=60, without injections).
Strain ratio of LHBT and supraspinatus tendons using ultrasound elastography.
The repeated-measures analysis of variance revealed no intragroup difference of the strain ratio of the LHBT (P=.412 for group 1, P=.936 for group 2, P=.131 for group 3) and supraspinatus tendon (P=.309 for group 1, P=.067 for group 2, P=.860 for group 3) across the 3 time points. Treating group 3 as the reference, the linear mixed model revealed no significant changes in tendon elasticity after either the standard subacromial injection (P=.205 for the LHBT and P=.529 for the supraspinatus tendon) or the dual-target injection (P=.961 for the LHBT and P=.831 for the supraspinatus tendon).
Elasticity of the LHBT and supraspinatus tendons is unlikely to change after a single dose of peritendinous or intrabursal corticosteroid injections. Future studies with a shorter follow-up interval are needed to validate whether corticosteroid injections can cause transient changes of the tendon's elasticity.
本研究旨在探讨超声引导下肩周或滑囊内皮质类固醇注射后肩袖肌腱的弹性是否发生变化。
具有 3 个月随访期的双盲、随机对照研究的事后二次分析。
门诊康复诊所。
患有肩峰下撞击综合征的患者（N=60）。
单侧肩部疼痛的患者被随机分配接受标准超声引导下肩峰下或双靶点皮质类固醇注射。在常规组中，冈上肌腱暴露于 40mg 曲安奈德，而后组中，单独向肱二头肌长头肌腱（LHBT）和冈上肌腱内注射 20mg 曲安奈德。将患者双侧肩部分为第 1 组（n=30，接受标准肩峰下注射）、第 2 组（n=30，接受双靶点注射）和第 3 组（n=60，无注射）。
超声弹性成像的 LHBT 和冈上肌腱的应变比。
重复测量方差分析显示，3 组内 LHBT 和冈上肌腱应变比无组内差异（第 1 组 P=.412，第 2 组 P=.936，第 3 组 P=.131）。以第 3 组为参照，线性混合模型显示，标准肩峰下注射（LHBT 为 P=.205，冈上肌腱为 P=.529）或双靶点注射（LHBT 为 P=.961，冈上肌腱为 P=.831）后，肌腱弹性均无显著变化。
单次关节周或滑囊内皮质类固醇注射后，LHBT 和冈上肌腱的弹性不太可能发生变化。需要进行随访时间更短的进一步研究，以验证皮质类固醇注射是否会导致肌腱弹性的短暂变化。
