Marks Darryn, Thomas Michael, Newans Tim, Bisset Leanne
Bond University, Faculty of Health Sciences and Medicine, Department of Physiotherapy, Bond Institute of Health and Sport, Promethean Way, Robina, Gold Coast, Queensland, 4226, Australia; Gold Coast University Hospital, Orthopaedic Department, Gold Coast, Qld, Australia.
Gold Coast University Hospital, Orthopaedic Department, Gold Coast, Qld, Australia; Bond University, Department of Medicine, Faculty of Health Science and Medicine, University Drive, Robina, Gold Coast, Qld, 4226, Australia.
Musculoskelet Sci Pract. 2023 Apr;64:102726. doi: 10.1016/j.msksp.2023.102726. Epub 2023 Feb 10.
Subacromial injection is known to influence pain of subacromial origin, yet its association with conservative care outcomes is unknown. This study investigated whether immediate response to subacromial injection of corticosteroid and local anaesthetic is associated with conservative care outcomes at 12 weeks post injection and/or progression to surgery.
prospective prognostic cohort study.
Sixty-four participants with subacromial related shoulder pain attending initial orthopaedic outpatient appointment at an Australian public hospital, received subacromial injection of corticosteroid and local anaesthetic followed by up to 12 weeks of physiotherapy. Immediate response to injection was measured by change in shoulder range of motion (ROM) and pain immediately (within 20 min) before and after injection. The Shoulder Pain and Disability Index (SPADI) was measured at baseline, 6 and 12-weeks.
Backward stepwise linear regression revealed immediate post-injection improvement in pain-free ROM (p = 0.001) and higher baseline symptoms (p = 0.016) were significantly associated with better 12-week SPADI outcomes. Longer symptom duration (p = 0.029) and higher age (p = 0.013) were significantly associated with poorer outcomes. Only 11 individuals progressed to surgery. The resultant model could explain 35% of the variation in change in SPADI at 12 weeks.
Improvement in pain-free shoulder ROM immediately post injection is significantly associated with better 12-week conservative care outcomes. This information, derived from within consultation injection responses, could help inform decisions about potential treatment options. Further research with higher numbers and longer-term patient-reported outcomes could further clarify these findings.
Australia and New Zealand Clinical Trials Registry 21 May 2012: 12612000532808.
已知肩峰下注射会影响肩峰源性疼痛，但其与保守治疗效果的关联尚不清楚。本研究调查了肩峰下注射皮质类固醇和局部麻醉剂后的即时反应是否与注射后12周的保守治疗效果和/或手术进展相关。
前瞻性预后队列研究。
64名因肩峰相关肩部疼痛在澳大利亚一家公立医院初次骨科门诊就诊的参与者，接受了肩峰下皮质类固醇和局部麻醉剂注射，随后进行了长达12周的物理治疗。通过注射前后立即（20分钟内）肩部活动范围（ROM）和疼痛的变化来测量注射后的即时反应。在基线、6周和12周时测量肩部疼痛和残疾指数（SPADI）。
向后逐步线性回归显示，注射后即时无痛ROM的改善（p = 0.001）和更高的基线症状（p = 0.016）与12周时更好的SPADI结果显著相关。症状持续时间较长（p = 0.029）和年龄较大（p = 0.013）与较差的结果显著相关。只有11人进展为手术。最终模型可以解释12周时SPADI变化的35%。
注射后即时无痛肩部ROM的改善与12周更好的保守治疗效果显著相关。从会诊注射反应中获得的这些信息有助于为潜在治疗方案的决策提供参考。对更多数量和长期患者报告结果的进一步研究可以进一步阐明这些发现。
澳大利亚和新西兰临床试验注册中心2012年5月21日：12612000532808。
