[Clinical efficacy of ultrasound-guided subacromial drug injection in the treatment of subacromial impingement syndrome]

Abstract

Objective: To evaluate the clinical effects of ultrasound-guided subacromial injection of two drugs in treatment of subacromial impingement syndrome. Methods: This was a randomized controlled trial study, prospective collection of patients' data who were diagnosed as subacromial impingement syndrome at Orthopedic of Tianjin Fifth Central Hospital from January 2015 to August 2017. To ensure the randomness of the study, patients were randomized into two groups using a random number table. Pain(visual analogue scale(VAS)) and shoulder function (University of California Shoulder Score System(UCLA) and shoulder abduction) were performed before and after each injection.For continuous endings with multiple points in time, firstly, the normality, the homogeneity of variance, and the sphericity test of Mauchly were performed. After the condition was satisfied, the variance analysis of the two-factor repeated measurement data was performed. Results: Fifty-two patients completed the injection within 5 minutes and 41 patients got the final follow-up. Twenty-two patients in the corticosteroid group, 14 males and 8 females, aged (44.7±9.5) years old(range: 35-68 years old). The lesion involved 13 cases of superior shoulder, more than 1 time injection in 4 cases. There were 19 patients in the NSAID group, 7 males and 12 females, aged (37.2±10.1) years old(range: 27-63 years old), 10 cases with lesions involving superior shoulders, and 1 case with more than one injection. (1)VAS score: compared with pre-injection(Corticosteroid group 5.0(4.0-6.0)and NSAIDS group 5.0(4.0-6.0)), both groups showed significant pain relief at 60 minutes(1.0(1.0-2.0)and 1.0(1.0-2.0)) and 6 weeks(1.5(1.0-2.0)and 1.0(1.0-2.0)) after injection(χ²=47.293, 41.173, 45.174, 40.113; P<0.01). (2)UCLA score: compared with pre-injection(30.2±2.5 and 30.5±3.0), UCLA scores improved significantly in both groups at the 6-week after injection(Corticosteroid group: MD=9.727, t=19.218, P<0.001; NSAID Group: MD=9.579, t=11.467, P<0.01). The UCLA score improvement between the two groups was no statistical difference(all P>0.05). (3)shoulder abduction degree: compared with pre-injection(92.7±9.4 and 93.2±11.6), the abduction degree was significantly improved in both groups at 60 minutes(131.8±9.6 and 127.4±16.6) and 6 weeks(115.9±9. 1 and 127.9±14.4) after the injection, but the improvement in each time point has no statistical correlation(MD=4.450, t=1.069, P=0.292). NSAID group had better improvement of shoulder abduction degree than corticosteroid group at the 6 weeks after the injection(MD=-11.986, t=-3.238, P=0.002). Conclusions: Ultrasound-guided subacromial injection can reduce pain in patients with subacromial impingement syndrome.The effect of injection of NSAID drugs is the same as corticosteroid drugs, it can avoid hormone-induced complications and reduce the repeat of the punctures.

Keywords: Hormones; Nonsteroidal antiinflammatory drug; Shoulder impingement syndrome; Ultrasound-guided.