Background On Shoulder Pain and Cortisone for Swimming Shoulder Pain
Shoulder impingement is the most common form of a shoulder injury in swimming. In recent years, two types of impingement have been classified. In swimming, secondary impingement is more common with the traditional subacromial (primary) impingement occurring more frequently in those with decreased range of motion. However, this pathology still occurs in swimmers.
In subacromial impingement, corticosteroid injections or cortisone is a common treatment despite the conflicting results of efficacy in the literature. One theory for this discrepancy is the accuracy of the cortisone injection.
This studied compared the accuracy of ultrasound (US)-guided cortisone injections with a blind technique. Dogu et al. also compared the correlation between the accuracy of the injection location and the improvement of clinical outcome.
What was done
To determine impingement, a plethora of manual clinical tests in a combination of MRI were used. This study also excluded those without pain for three months, any with neurological deficits, those with any other pathology seen on the MRI, and those who have tried any form of treatment (physical therapy, medication, etc.).
The patients included were then randomized into two groups: US-guided subacromial injection or blind injection. The injections were given by a physiatrist using a posterior approach with the patient in a seated, upright position. Both groups contained 23 patients.
The patients were evaluated two times, before treatment and six weeks after treatment onset for evaluation of the range of motion, and pain.
In the two groups, there was no significant difference in accuracy (group 1: 15/23 and group 2: 16/23 accurate). Both groups had improvement in range of motion values at the end of six weeks. Despite the injection accuracy, the patients showed improvement in the studied parameters. However, the pain level did not resolve completely and remained on average a 3/10 on the visual analog scale with movement.
Cortisone injections with and without US-guided injection demonstrate similar accuracy, but the accuracy does not appear to influence improvement. Pain and functional levels improved with the injection after six weeks.
The use of cortisone injections is beneficial for subacromial impingement, but the resolution of symptoms did not occur with movement after six weeks. Therefore, in cases of subacromial impingement, US-guided or blinded cortisone injections are helpful but should remain an adjunct of treatment, as pain still remained, especially in swimmers where the complete resolution of symptoms is essential.
- Dogu B, Yucel SD, Sag SY, Bankaoglu M, Kuran B.Blind or Ultrasound-Guided Corticosteroid Injections and Short-Term Response in SubacromialImpingement Syndrome: A Randomized, Double-Blind, Prospective Study. Am J Phys Med Rehabil. 2012 May 2
Originally Posted June 2012