A Prospective Study of 100 Patients with Rotator Cuff Tendinopathy Showed No Correlation Between Subacromial Bursitis and the Efficacy of Ultrasound-guided Corticosteroid Injection

Overview

Journal Eur Radiol

Specialty Radiology

Date 2023 Aug 4

PMID 37540320

Authors

Benoit Metayer

Alban Fouasson-Chailloux

Benoit Le Goff

Christelle Darrieutort-Laffite

Affiliations

Soon will be listed here.

Abstract

Objectives: The objective of this study was to determine whether the presence of subacromial bursitis in patients with rotator cuff tendinopathy (RCT) was associated with a better outcome after ultrasound (US)-guided subacromial corticosteroid injection.

Methods: A single-center prospective study was performed including patients referred for subacromial injection to manage RCT. At baseline, all patients received an US-guided intra-bursal injection of betamethasone (1 ml). The primary endpoint was reduced pain 3 months (M3) after the procedure: a good responder was defined by a decrease in Visual Analogue Scale pain of more than 30%. Secondary endpoints included functional recovery assessed by the Oxford Shoulder Score (OSS) and clinical success at 6 weeks (W6). We also explored the association between good clinical response and other factors, such as US or X-ray features.

Results: One hundred patients were included and 49 presented with subacromial bursitis. At M3, 60% of patients (54/100) were considered good responders. The rate of good responders did not differ between the bursitis and non-bursitis groups (p = 0.6). During follow-up, OSS improved over time whether bursitis was present or not. We did not find any US or X-ray features significantly associated with a favorable clinical outcome.

Conclusion: The presence of subacromial bursitis did not influence clinical outcomes at 3 months post-subacromial injection in patients suffering from RCT.

Clinical Relevance Statement: The presence of subacromial bursitis did not influence clinical outcomes at 3 months post-subacromial corticosteroid injection in patients with rotator cuff tendinopathy. For patient management, looking for ultrasonographic signs of bursitis does not appear relevant for the indication of the injection.

Key Points: • Ultrasound-guided subacromial corticosteroid injections led to a significant improvement in 60% of patients suffering from rotator cuff tendinopathy. • The presence of subacromial bursitis was not associated with better improvement at 3 months post-injection. • Except for the Minnesota score referring to job satisfaction, we did not find any baseline clinical, X-ray, or ultrasound characteristics associated with a successful outcome.

References

Speed C, Hazleman B . Sonographic assessment of shoulder complaints in rheumatic diseases. J Rheumatol. 1999; 26(10):2282-3. View

Scott A, Ashe M . Common tendinopathies in the upper and lower extremities. Curr Sports Med Rep. 2006; 5(5):233-41. DOI: 10.1097/01.csmr.0000306421.85919.9c. View

Linaker C, Walker-Bone K . Shoulder disorders and occupation. Best Pract Res Clin Rheumatol. 2015; 29(3):405-23. PMC: 4836557. DOI: 10.1016/j.berh.2015.04.001. View

Hohmann E, Glatt V, Tetsworth K . Subacromial Decompression in Patients With Shoulder Impingement With an Intact Rotator Cuff: An Expert Consensus Statement Using the Modified Delphi Technique Comparing North American to European Shoulder Surgeons. Arthroscopy. 2021; 38(4):1051-1065. DOI: 10.1016/j.arthro.2021.09.031. View

Naredo E, Cabero F, Beneyto P, Cruz A, Mondejar B, Uson J . A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder. J Rheumatol. 2004; 31(2):308-14. View

Wu T, Song H, Dong Y, Li J . Ultrasound-guided versus blind subacromial-subdeltoid bursa injection in adults with shoulder pain: A systematic review and meta-analysis. Semin Arthritis Rheum. 2015; 45(3):374-8. DOI: 10.1016/j.semarthrit.2015.05.011. View

Plafki C, Steffen R, Willburger R, Wittenberg R . Local anaesthetic injection with and without corticosteroids for subacromial impingement syndrome. Int Orthop. 2000; 24(1):40-2. PMC: 3619854. DOI: 10.1007/s002640050010. View

Dimitroulas T, Hirsch G, Kitas G, Klocke R . Clinical outcome of ultrasound-guided steroid injections for chronic shoulder pain. Int J Rheum Dis. 2013; 16(4):398-402. DOI: 10.1111/1756-185x.12023. View

Hambly N, Fitzpatrick P, MacMahon P, Eustace S . Rotator cuff impingement: correlation between findings on MRI and outcome after fluoroscopically guided subacromial bursography and steroid injection. AJR Am J Roentgenol. 2007; 189(5):1179-84. DOI: 10.2214/AJR.07.2421. View

10.

Puzzitiello R, Patel B, Forlenza E, Nwachukwu B, Allen A, Forsythe B . Adverse Impact of Corticosteroids on Rotator Cuff Tendon Health and Repair: A Systematic Review of Basic Science Studies. Arthrosc Sports Med Rehabil. 2020; 2(2):e161-e169. PMC: 7190543. DOI: 10.1016/j.asmr.2020.01.002. View

11.

Chang K, Wu W, Han D, Ozcakar L . Static and Dynamic Shoulder Imaging to Predict Initial Effectiveness and Recurrence After Ultrasound-Guided Subacromial Corticosteroid Injections. Arch Phys Med Rehabil. 2017; 98(10):1984-1994. DOI: 10.1016/j.apmr.2017.01.022. View

12.

Lee D, Hong J, Lee M, Kwack K, Yoon S . Relation Between Subacromial Bursitis on Ultrasonography and Efficacy of Subacromial Corticosteroid Injection in Rotator Cuff Disease: A Prospective Comparison Study. Arch Phys Med Rehabil. 2016; 98(5):881-887. DOI: 10.1016/j.apmr.2016.11.025. View

13.

Bouju Y, Bouilleau L, Dubois de Montmarin G, Bacle G, Favard L . Do subacromial ultrasonography findings predict efficacy of intra-bursal injection? Prospective study in 39 patients. Orthop Traumatol Surg Res. 2014; 100(8 Suppl):S361-4. DOI: 10.1016/j.otsr.2014.09.003. View

14.

Chang K, Chen W, Wang T, Hung C, Chien K . Quantitative ultrasound facilitates the exploration of morphological association of the long head biceps tendon with supraspinatus tendon full thickness tear. PLoS One. 2014; 9(11):e113803. PMC: 4239113. DOI: 10.1371/journal.pone.0113803. View

15.

Park T, Park D, Kim S, Kweon T . Roentgenographic assessment of acromial morphology using supraspinatus outlet radiographs. Arthroscopy. 2001; 17(5):496-501. DOI: 10.1053/jars.2001.23579. View

16.

Farrar J, Portenoy R, Berlin J, Kinman J, Strom B . Defining the clinically important difference in pain outcome measures. Pain. 2000; 88(3):287-294. DOI: 10.1016/S0304-3959(00)00339-0. View

17.

Grilo R, Treves R, Preux P, Vergne-Salle P, Bertin P . Clinically relevant VAS pain score change in patients with acute rheumatic conditions. Joint Bone Spine. 2007; 74(4):358-61. DOI: 10.1016/j.jbspin.2006.06.019. View

18.

Cadogan A, McNair P, Laslett M, Hing W . Diagnostic Accuracy of Clinical Examination and Imaging Findings for Identifying Subacromial Pain. PLoS One. 2016; 11(12):e0167738. PMC: 5147961. DOI: 10.1371/journal.pone.0167738. View

19.

Derendorf H, Mollmann H, Gruner A, Haack D, Gyselby G . Pharmacokinetics and pharmacodynamics of glucocorticoid suspensions after intra-articular administration. Clin Pharmacol Ther. 1986; 39(3):313-7. DOI: 10.1038/clpt.1986.45. View

20.

Fawcett R, Grainger A, Robinson P, Jafari M, Rowbotham E . Ultrasound-guided subacromial-subdeltoid bursa corticosteroid injections: a study of short- and long-term outcomes. Clin Radiol. 2018; 73(8):760.e7-760.e12. DOI: 10.1016/j.crad.2018.03.016. View