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Ultrasound guided
injections improve the likelihood of pain relief. Seven Requirements for Prescribing Opiates Advanced Treatments for Chronic Headaches to see a list of other articles
from the private practice of Neal S. Taub, MD. |
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A Letter Released
to Physicians on January 22, 2007 How to Improve the Efficacy of Shoulder Injections Corticosteroid
injections serve as one of the principal medical treatments for shoulder pain1,
and recent research sheds new light on how this treatment can
be made more consistently effective.
Since 1997, numerous studies have used radiography or MRI to assess
the accuracy of shoulder injections.
Even in expert hands, accuracy of injections has proved to be as low
as 29% in subacromial injections.2 Three other studies have found overall
accuracy to be closer to 70%.3-5
Researchers have assessed the accuracy of subacromial
injections and glenohumeral injections in the hands
of rheumatologists, orthopedic surgeons and others. They have studied posterior, anteromedial, and anterior approaches. No one approach stands out as particularly
accurate. These four studies also
demonstrated that a physician’s confidence in the injection did not correlate
strongly with an accurate infiltration.
When the
physician was confident that he had accurately infiltrated the correct
structure, he was right only 66% to 75% of the time. Where
shoulder injections are concerned, accuracy seems to correlate with
efficacy. One study
published in 2002 suggests that when practitioners miss the subacromial bursa and instead infiltrate the deltoid
muscle, that pain relief is still achieved.3 However, older and more recent studies
found that accuracy affects the efficacy of shoulder injections.2,5,6 The most recent study was the only one to
use MRI to gauge injection accuracy, and it showed that practitioners will
sometimes infiltrate many different structures in the course of one
injection. Henkus
et al also found that injections into the rotator cuff muscle caused
increased pain.6 Hypothesizing
that increased accuracy would improve the results of shoulder injections, Naredo et al compared ultrasound guided injections with
palpation guided injections.6
They treated 41 shoulder pain patients with no history of trauma,
chronic inflammatory arthritis, or physical therapy treatment. They assessed patients before injection and
six weeks post-injection. On a visual analog scale for
pain ranging from 0 to 100, the ultrasound guided injections created an
average improvement of 35 points while the palpation guided injections
created an average improvement of only seven points. On a shoulder function assessment scale of
0 to 70, the ultrasound guided injections created an average improvement of
15 points while the palpation guided injections only
averaged a 6 point improvement. Implications
for your practice •
A
high incidence of palpation guided injections that miss the subacromial bursa suggests that repeated palpation guided
injections to the shoulder may be contraindicated. •
Neal
Taub, MD, ABPM&R performs ultrasound guided
injections at his physiatry practice in •
Alternatively,
when palpation guided injections fail to produce the desired results, a
referral to Dr. Taub for ultrasound guided
injections can be considered. Ultrasound
guidance can also improve outcomes when you refer for injections of the knee,
sacroiliac, piriformis, wrist, or plantar fascia. The private, physiatry practice of Dr. Neal
S. Taub is referral based. Dr. Taub
treats for specific complaints falling under the physiatry realm of expertise
and returns your patient to you for ongoing care. |
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Home Stroke Rehabilitation About Neal Taub, MD What is a Physiatrist |
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