Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands.
MSK Clinic, Leiden, The Netherlands.
J Back Musculoskelet Rehabil. 2023;36(2):317-322. doi: 10.3233/BMR-210360.
Accuracy of blind intra-articular injections for the shoulder is rather low. It is unclear whether accurate injections for capsulitis of the shoulder are more effective than inaccurate injections.
It has been hypothesized that a squishing sound following an intra-articular injection with a mixture of air and fluid means that the injection was accurately placed and that the efficacy of accurately placed injections is greater than that of inaccurate injections. The aim of the present study was to test the hypothesis that a squishing sound following an injection predicts a better clinical result.
Files were selected of patients with capsulitis of the shoulder, who were treated with an intra-articular injection containing a mixture of triamcinolone, lidocaine, and air. After the injection, the shoulder was moved to determine whether a squishing sound could be produced. Efficacy was measured after two weeks according to the Patient Global Impression of Change scale. Differences in efficacy between injections with and without a squishing sound were expressed as an odds ratio.
Sixty-one patients were selected. Squishing was heard after 47 injections (77%). Two weeks after the injection, a positive outcome was reported by 49 patients (80%). When squishing was heard, the effect was positive in 42 of the 47 patients (89%) and when no squishing was heard, the effect was positive in 7 of the 14 patients (50%). The odds ratio was 8.4 (95% CI 2.1-34.0; p= 0.003).
Efficacy of injections with a mixture of triamcinolone, lidocaine, and air for capsulitis of the shoulder is significantly greater when a squishing sound was heard after the injection. We hypothesize that squishing is related to accuracy and accuracy to efficacy. A future study with X-ray arthrography is needed to verify both hypotheses.
对于肩关节的关节内注射，盲目操作的准确率相当低。目前尚不清楚对于肩关节囊炎的准确注射是否比不准确的注射更有效。
有假说认为，在关节内注射空气和液体的混合物后，如果能听到一种“嘎吱”声，则表示注射位置准确，而且准确注射的疗效要好于不准确的注射。本研究旨在验证下述假说，即注射后听到“嘎吱”声可预测更好的临床效果。
选取了接受关节内注射三联药物（曲安奈德、利多卡因和空气）治疗的肩关节囊炎患者的病历。注射后，移动肩部以确定是否能产生“嘎吱”声。根据患者整体改善变化量表（Patient Global Impression of Change scale），在注射后两周评估疗效。注射时有和没有“嘎吱”声的疗效差异用优势比（odds ratio）表示。
共选取了 61 名患者。47 次注射（77%）时可听到“嘎吱”声。注射后两周，49 名患者（80%）报告疗效良好。在听到“嘎吱”声的 47 次注射中，有 42 次（89%）疗效良好，而在未听到“嘎吱”声的 14 次注射中，有 7 次（50%）疗效良好。优势比为 8.4（95%CI 2.1-34.0；p=0.003）。
在肩关节囊炎的三联药物关节内注射中，如果注射后能听到“嘎吱”声，则疗效显著提高。我们推测“嘎吱”声与准确性有关，而准确性与疗效有关。需要进一步行 X 射线关节造影术研究来验证这两个假说。
