Appendix 1 Landmark Technique Accuracy and Outcome Studies
4. Clinical studies of accurate placement and outcomes between landmark and image guided techniques.
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
| Lead author Year Subject Study type |
Accuracy % (proportion of tendon sheaths injected) |
|---|
