Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Glenohumeral versus subacromial steroid injections for impingement syndrome with mild stiffness: a randomized controlled trial

  • Yong-Tae Kim (Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital) ;
  • Tae-Yeong Kim (Department of Orthopedic Surgery, Hallym University Chuncheon Sacred Heart Hospital) ;
  • Jun-Beom Lee (Department of Orthopedic Surgery, Hallym University Chuncheon Sacred Heart Hospital) ;
  • Jung-Taek Hwang (Department of Orthopedic Surgery, Hallym University Chuncheon Sacred Heart Hospital)
  • Received : 2023.05.06
  • Accepted : 2023.07.12
  • Published : 2023.12.01
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Abstract

Background: The subacromial (SA) space is a commonly used injection site for treatment of impingement syndrome. For shoulder stiffness, glenohumeral (GH) injections are commonly performed. However, in cases of impingement syndrome with mild shoulder stiffness, the optimal site of steroid injection has yet to be identified. Methods: This prospective, randomized study compared the short-term outcomes of ultrasound-guided GH and SA steroid injections in patients who were diagnosed with impingement syndrome and mild stiffness. Each group comprised 24 patients who received either a GH or SA injection of 40 mg of triamcinolone. Range of motion and clinical scores were assessed before and 3, 7, and 13 weeks after the injection. Results: GH and SA injections significantly improved the range of motion and clinical scores after 13 weeks of follow-up. Notably, targeting the GH joint resulted in an earlier gain of forward elevation, external rotation, and internal rotation in 3 weeks (P<0.001, P=0.012, and P=0.002, respectively) and of internal rotation and a Constant-Murley score in 7 weeks (P<0.001 and P=0.046). Subsequent measurements were similar between the groups and showed a steady improvement in all ranges of motion and clinical scores. Conclusions: GH injections may be more favorable than SA injections for treatment of impingement syndrome with mild stiffness, especially in improving the range of motion in the early period. However, the procedures showed similar outcomes after 3 months. Level of evidence: I.

Keywords

Acknowledgement

The authors would like to thank Myung Sun Hong, MD, a musculoskeletal radiologist with 20 years of experience working at Hallym University Chuncheon Sacred Heart Hospital, for performing the diagnostic ultrasound and magnetic resonance imaging interpretations.

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