Technique Accuracy and Outcome Studies

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Appendix 1 Landmark Technique Accuracy and Outcome Studies

For references please see the list for Section 1, Landmark and image guided injections, page 54–59. The tables summarize:

Cadaver studies were landmark guided and used dye injection and dissection to determine accuracy of placement unless otherwise stated.

Glenohumeral joint

Lead author
Year
Subject
Study type
Accuracy % (proportion of joints injected) Clinical outcomes where relevant Comments (imaging assessment)
Sethi 18 2006
Cadaver Accuracy
Anterior approach 80% (16/20)
Posterior approach 50% (10/20)
(X-ray with contrast)
Hanchard22 2006
Cadaver Accuracy
74–91% (worst and best results for different approaches) Best results with ‘optimized’ technique; 16% dispersal into other structures
Esenyel81 2010
Cadaver Accuracy
Anterior 96% (48/50) 4% were in surrounding tissues and capsule
Sethi19 2005
Clinical Accuracy
Anterior 27% (11/41) Insertion just lateral to the coracoid.
Most common misplacement either too medial or too superficial in the deltoid muscle (MRI arthrography)
Lee57 2009
Clinical Outcome
Posterior landmark guided (22) vs
Ultrasound guided (21) (43 patients with frozen shoulder)
2 weeks post-injection improvement was significantly greater in the US-guided injection group, but there was no significant difference in the improvement between the 2 groups beyond the 3rd week up to 6 weeks
Hegedus2 2010
Clinical Accuracy and Outcome
Multiple approaches 52% (54/103) 4 weeks post-injection equal improvement in all regardless of accuracy, despite wide variance in subject duration of symptoms, multiple injectors with varied training, and multiple injection approaches. Accuracy did not appear to depend on the experience of the physician (X-ray fluoroscopy)
Eustace17 1997
Clinical Accuracy and Outcome
42% (10/24) There were significant differences in outcome between the accurately placed and the inaccurately placed groups (X-ray with contrast)

Subacromial space

Lead author
Year Subject
Study type
Accuracy % (proportion of joints injected) Clinical outcomes where relevant
Comments (imaging assessment)
Partington21 1998
Cadaver Accuracy
83% (20/24) Other structures also infiltrated in 15 shoulders incl. 7 into the cuff
Hanchard22 2006
Cadaver Accuracy
91% Best results with ‘optimized’ technique; 19% dispersal into other structures
Rutten26 2007
Clinical Accuracy
Ultrasound guided 100% (10/10) vs
Landmark guided 100% (10/10)
(MRI arthrography)
Yamakado33 2002
Clinical Accuracy
70% (39/56) 12 (21%) were in the deltoid muscle, 2 (4%) were in the glenohumeral joint, 3 (5%) were subcutaneous. Comparison of subacromial bursal with intradeltoid injection showed no immediate significant differences in pain reduction expressed as impingement signs (X-ray with contrast)
Kang34 2008
Clinical Accuracy and Outcome
Anterolateral 70% (14/20)
Lateral 70% (14/20)
Posterior 70% (14/20)
At 3 months there was significant clinical improvement that did not correlate with accuracy.
Accuracy not related to body mass index (X-ray with contrast)
Naredo58 2004
Clinical Accuracy and Outcome
Landmark guided (20) vs. Ultrasound guided (21) 6 weeks post-injection, there was significantly greater improvement with US versus LG. Suggest that US guided injections should be indicated, at least, in patients with poor response to previous blind injection to ensure accurate medication placement (ultrasound)
Esenyel27 2003
Clinical Accuracy and Outcome
Anterolateral 87% (42/48) 2 weeks after treatment, failure of accurate placement was associated with return to pre-treatment values, while significant improvement continued in the other group (X-ray with contrast)
Eustace17 1997
Clinical Accuracy and Outcome
29% (4/14) There were significant differences in outcome between the accurately placed and the inaccurately placed groups (X-ray with contrast)

Acromioclavicular joint

Lead author
Year Subject
Study type
Accuracy % (proportion of joints injected) Comments (imaging assessment)
Partington21 1998
Cadaver Accuracy
67% (16/24) Other structures also infiltrated in 8 shoulders
Pichler3 2009
Cadaver Accuracy
57% (33/76) Skilled specialist and inexperienced resident equally accurate.
(Specialist 20/20 accurate with use of an image intensifier)
Bisbinas35 2006
Clinical Accuracy
40% (26/66) Injections were misplaced laterally in 21 injections (31.8%), medially in 13 (19.8%), anteriorly in 3 (4.5%) and inferiorly in 3 (4.5%) (image intensifier)

Suprascapular nerve

Lead author
Year Subject
Study type
Study protocol Clinical outcomes Comments
Shanahan59 2004
Clinical Outcome
Landmark guided vs CT guided (77 shoulders in 67 patients) 12 weeks post-injection, significant improvements in pain scores and disability with both types of nerve block, no difference in the improvement between the two at any time. No significant adverse effects occurred in either group. Patient satisfaction scores for pain relief high for both

De quervain’s

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Lead author
Year Subject
Study type
Accuracy % (proportion of tendon sheaths injected)