Ultrasound-Guided Versus Anatomic Landmark-Guided Steroid Injection of the Subacromial Bursa in the Management of Subacromial Impingement: A Systematic Review of Randomised Control Studies

Abstract

This study is a systematic review of prospective randomised control studies comparing ultrasound-guided steroid injection of the subacromial space with anatomic landmark-guided injection in the treatment of subacromial impingement to determine if there is any difference in pain relief and functional outcome. Mesh terms and free-text words search of electronic databases, reference list of identified studies and grey literature was performed using the PICO format. All identified papers were sifted sequentially by title, abstract and review of full text articles. Four papers qualified and were included in the review and analysis. The total number of patients in the studies was 234 patients with 117 patients randomised to each of landmark-guided and ultrasound-guided injection groups. There was no statistically significant difference in VAS pain scores (P = 0.67), SDQ scores (P = 0.43), SPADI disability score (P = 0.17) and functional outcomes scores (P = 0.09) at 4 to 6 weeks when USS-guided subacromial steroid injection was compared with landmark-guided injection. SPADI pain scores (P = 0.02) demonstrates significant reduction in favour of landmark-guided injection. There was low to moderate risk of bias. In conclusion, ultrasound-guided subacromial steroid injection does not offer any statistically significant clinical improvement over landmark-guided injection in adults with subacromial impingement.

Keywords: Anatomic landmark guided injection; Steroid injection; Subacromial bursitis; Subacromial impingement; Ultrasound guided injection.

Fig. 1

Prisma chart of the study selection process

Fig. 2

Analysis and forest plot of reduction in VAS pain scores at 4–6 weeks follow-up following steroid injection in both groups

Fig. 3

Analysis and forest plot of reduction in SDQ scores at 4–6 weeks follow-up following steroid injection in both groups

Fig. 4

Analysis and forest plot of reduction in SPADI pain scores at 4–6 weeks follow-up following steroid injection in both groups

Fig. 5

Analysis and forest plot of improvement in SPADI disability scores at 4–6 weeks follow-up following steroid injection in both groups

Fig. 6

Analysis and forest plot of improvement in function scores at 4–6 weeks follow-up following steroid injection in both groups

Fig. 7

Funnel plot of comparison: ultrasound versus blind injection, outcome: VAS pain score at 4–6 weeks post steroid injection

Fig. 8

Risk of bias graph