Uysal Alper
Physical Medicine and Rehabilitation, Mersin City Training and Research Hospital, Mersin, TUR.
Cureus. 2025 Feb 14;17(2):e79008. doi: 10.7759/cureus.79008. eCollection 2025 Feb.
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.
背景 本研究旨在比较超声（US）引导下肩峰下滑囊类固醇注射（SABSI）、肩胛上神经阻滞（SSNB）以及联合注射疗法（SABSI + SSNB）对肩峰下撞击综合征患者疼痛和肩部功能的疗效，这些患者对物理医学与康复治疗（PM&R）无反应或报告无法定期前往PM&R科室就诊。方法 在这项前瞻性、比较性队列研究中，采用信封法对患者进行随机分组，以确保无偏分布。总共95例肩峰下撞击综合征患者根据所应用的注射技术分为三组。所有注射均在超声引导下应用于第1组（SABSI）、第2组（SSNB）和第3组（SABSI + SSNB）。分别使用视觉模拟量表（VAS）和手臂、肩部和手部功能障碍（DASH）量表评估各组在治疗前以及治疗后1个月和3个月时的疼痛和肩部功能水平。对于统计分析，使用Shapiro-Wilk检验评估连续数据的正态性。对于正态分布变量，应用经Bonferroni校正的单因素方差分析，而对于非正态分布数据，则使用Kruskal-Wallis检验。进行Pearson卡方检验以比较分类变量。结果 在治疗前与治疗后1个月之间，各组在VAS静息评分、VAS活动评分和DASH评分的百分比变化方面存在统计学显著差异（p分别为0.004、<0.001和<0.001）。这些显著差异在治疗前至治疗后3个月期间持续存在，所有p值均≤0.002。在两个评估间隔期间，第1组和第2组在所有参数上的百分比变化在统计学上相似；然而，这些变化显著低于第3组观察到的变化。与对PM&R无反应的患者相比，无法前往PM&R科室就诊的患者症状持续时间更长（p = 0.015）。这两种注射技术在两组中的分布相似（p = 0.831），并且两组在疼痛和功能方面对超声引导下注射的反应相似（所有p>0.05）。结论 对于肩部撞击综合征患者，发现超声引导下SABSI联合SSNB在改善肩部疼痛和功能方面优于单独应用。这些发现表明，联合方法是管理肩峰下撞击综合征的一种有前景的替代方案，特别是对于面临PM&R治疗障碍的患者。
