Efficacy of Ultrasound-Guided Injections in Patients Unable to Access or Benefit From Physical Therapy: A Comparative Study of Subacromial Corticosteroid Injection, Suprascapular Nerve Block, and Their Combination in Shoulder Impingement Syndrome.

Background This study aims to compare the efficacy of ultrasound (US)-guided subacromial bursa steroid injection (SABSI), suprascapular nerve block (SSNB), and combined injection therapy (SABSI + SSNB) on pain and shoulder function in patients with subacromial impingement syndrome who either did not respond to physical medicine and rehabilitation (PM&R) or reported being unable to attend the PM&R unit regularly. Methodology In this prospective, comparative cohort study, patients were randomly assigned using the envelope method to ensure an unbiased distribution. In total, 95 patients with subacromial impingement syndrome were divided into three groups according to the injection technique applied. All injections were applied to Group 1 (SABSI), Group 2 (SSNB), and Group 3 (SABSI + SSNB) under US guidance. Pain and shoulder function levels of the groups before and after treatment at one month and three months were evaluated using the Visual Analog Scale (VAS) and the Disabilities of the Arm, Shoulder and Hand (DASH) scale, respectively. For statistical analysis, the Shapiro-Wilk test was used to assess the normality of continuous data. One-way analysis of variance with Bonferroni correction was applied for normally distributed variables, while the Kruskal-Wallis test was used for non-normally distributed data. Pearson's chi-square test was performed to compare categorical variables. Results Between pre-treatment and one month post-treatment, there were statistically significant differences in the percentage change of VAS rest, VAS activity, and DASH scores among the groups (p = 0.004, <0.001, and <0.001, respectively). These significant differences persisted over the period from pre-treatment to three months post-treatment, with all p-values being ≤0.002. Throughout both assessment intervals, Groups 1 and 2 displayed statistically similar percentage changes across all parameters; however, these changes were significantly lower than those observed in Group 3. Patients unable to attend PM&R units displayed a longer symptom duration compared to patients who were non-responders to PM&R (p = 0.015). The distribution of these three injection techniques across the two groups was similar (p = 0.831), and both groups showed similar responses to US-guided injections in terms of pain and functionality (all p > 0.05). Conclusions US-guided SABSI combined with SSNB in patients with shoulder impingement was found to be superior compared to their sole applications in terms of improvement in shoulder pain and function. These findings suggest that the combined approach is a promising alternative for managing shoulder impingement syndrome, particularly in patients facing barriers to PM&R access.