Wu Wei-Ting, Lin Che-Yu, Shu Yi-Chung, Chen Lan-Rong, Özçakar Levent, Chang Ke-Vin
Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei City, Taiwan.
Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan.
Insights Imaging. 2025 Jul 1;16(1):145. doi: 10.1186/s13244-025-01989-5.
Subacromial impingement syndrome (SIS) frequently causes shoulder pain. This study aimed to (1) assess the predictive utility of quantitative dynamic subacromial ultrasound for ultrasound-guided dual-target injections and (2) compare the long-term efficacy of dual-target injections with standard subdeltoid-subacromial injections in SIS patients.
Patients with SIS received 40 mg of triamcinolone acetonide via ultrasound-guided dual-target injections (subdeltoid-subacromial bursa and long head of the biceps brachii tendon). Clinical assessments and static/dynamic ultrasound were performed at baseline and 4 weeks post-procedure. Minimal vertical acromiohumeral distance (mVAHD) was measured by tracing the humeral greater tuberosity against the acromion. A historical cohort receiving standard subdeltoid-subacromial corticosteroid injections was used for comparison.
Of 90 patients receiving dual-target injections, 70 (77.7%) achieved early treatment success. An enlarged minimal mVAHD was associated with success, except during the abduction phase in the full-can posture. Among these 70 patients, 25 (35.7%) had shoulder pain recurrence requiring repeat injections, linked to a decreased mVAHD across all phases and postures. Compared to 90 patients in a historical cohort receiving standard subdeltoid-subacromial injections, the dual-target group had a significantly longer mean time to pain recurrence (309.1 ± 130.1 days vs. 267.5 ± 184.2 days, p = 0.03).
Dynamic ultrasound metrics, including mVAHD, predict early success and pain recurrence following dual-target injections in SIS. Dual-target injections offer a longer duration of effectiveness compared to standard subdeltoid-subacromial injections. Future research should explore the predictive value of mVAHD with deep learning algorithms and evaluate the approach in adhesive capsulitis.
ClinicalTrials.gov (NCT04219527). Registered on 27 December 2019, https://clinicaltrials.gov/study/NCT04219527 .
Dynamic ultrasound metrics predict early success and pain recurrence following dual-target injections in SIS, offering a longer duration of effectiveness compared to standard subdeltoid-subacromial injections.
Dynamic ultrasound metrics predict injection success and pain recurrence in impingement. Dual-target injections offer a longer duration of effectiveness than standard injections. Future research should assess deep learning's predictive value in adhesive capsulitis.
肩峰下撞击综合征（SIS）常导致肩部疼痛。本研究旨在（1）评估定量动态肩峰下超声对超声引导下双靶点注射的预测效用，以及（2）比较双靶点注射与标准三角肌下-肩峰下注射对SIS患者的长期疗效。
SIS患者通过超声引导下双靶点注射（三角肌下-肩峰下滑囊和肱二头肌长头肌腱）接受40mg曲安奈德。在基线和术后4周进行临床评估及静态/动态超声检查。通过将肱骨大结节相对于肩峰进行追踪来测量最小垂直肩峰-肱骨距离（mVAHD）。使用接受标准三角肌下-肩峰下皮质类固醇注射的历史队列进行比较。
在90例接受双靶点注射的患者中，70例（77.7%）早期治疗成功。除了在全罐姿势的外展阶段，扩大的最小mVAHD与成功相关。在这70例患者中，25例（35.7%）出现肩部疼痛复发需要重复注射，这与所有阶段和姿势下mVAHD的降低有关。与历史队列中90例接受标准三角肌下-肩峰下注射的患者相比，双靶点组疼痛复发的平均时间显著更长（309.1±130.1天对267.5±184.2天，p=0.03）。
包括mVAHD在内的动态超声指标可预测SIS患者双靶点注射后的早期成功和疼痛复发。与标准三角肌下-肩峰下注射相比，双靶点注射的有效持续时间更长。未来的研究应探索深度学习算法对mVAHD的预测价值，并评估该方法在粘连性关节囊炎中的应用。
ClinicalTrials.gov（NCT04219527）。于2019年12月27日注册，https://clinicaltrials.gov/study/NCT04219527 。
动态超声指标可预测SIS患者双靶点注射后的早期成功和疼痛复发，与标准三角肌下-肩峰下注射相比，有效持续时间更长。
动态超声指标可预测撞击症注射的成功和疼痛复发。双靶点注射比标准注射的有效持续时间更长。未来的研究应评估深度学习在粘连性关节囊炎中的预测价值。
