Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Diagnostic value of a preoperative acromioclavicular injection for symptomatic acromioclavicular osteoarthritis: a retrospective study of cross-sectional midterm outcomes

  • Received : 2023.01.20
  • Accepted : 2023.07.26
  • Published : 2024.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: It is essential to distinguish between symptomatic- and asymptomatic radiographic acromioclavicular (AC) osteoarthritis (OA) because AC-targeted physical examinations are dubious. This study aimed to determine the diagnostic value of a preoperative AC injection in discriminating between symptomatic- and asymptomatic radiographic AC OA based on patient arthroscopic distal clavicle resection (aDCR) outcomes. Methods: Forty-eight patients who underwent aDCR for AC OA were included. Their satisfaction was objectified using a 5-point Likert scale and patient willingness to repeat the surgery. The Oxford Shoulder Score (OSS), the Subjective Shoulder Value (SSV), and the Numerical Rating Scale (NRS) were used to assess postoperative shoulder function and pain. Patients were subdivided into groups based on their good or minimal reaction to an AC injection (good reaction: ≥7 consecutive days of pain reduction, Minimal reaction: <7 consecutive days of pain reduction). Results: Twenty-seven patients had a good reaction and 21 patients had a minimal reaction to the AC injection (median follow-up, 45.0 months; range, 31.0-52.8 months). No significant differences were found in level of satisfaction (P=0.234) or willingness to repeat the surgery (P=0.861). No significant differences were found in OSS (P=0.612), SSV (P=0.641), NRS at rest (P=0.684) or during activity (P=0.422). Conclusions: This study found no significant differences between patients with a good reaction or a minimal reaction to an AC injection after aDCR surgery. The outcomes of this study seem to suggest that a distinction between symptomatic and asymptomatic radiographic AC OA is unnecessary, as all patients were equally satisfied with the outcome.

Keywords

References

  1. Luime JJ, Koes BW, Hendriksen IJ, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol 2004;33:73-81.  https://doi.org/10.1080/03009740310004667
  2. Gokkus K, Saylik M, Atmaca H, Sagtas E, Aydin AT. Limited distal clavicle excision of acromioclavicular joint osteoarthritis. Orthop Traumatol Surg Res 2016;102:311-8.  https://doi.org/10.1016/j.otsr.2016.01.008
  3. Pensak M, Grumet RC, Slabaugh MA, Bach BR. Open versus arthroscopic distal clavicle resection. Arthroscopy 2010;26:697-704.  https://doi.org/10.1016/j.arthro.2009.12.007
  4. Cadogan A, Laslett M, Hing WA, McNair PJ, Coates MH. A prospective study of shoulder pain in primary care: prevalence of imaged pathology and response to guided diagnostic blocks. BMC Musculoskelet Disord 2011;12:119. 
  5. Farrell G, Watson L, Devan H. Current evidence for nonpharmacological interventions and criteria for surgical management of persistent acromioclavicular joint osteoarthritis: a systematic review. Shoulder Elbow 2019;11:395-410.  https://doi.org/10.1177/1758573219840673
  6. Shubin Stein BE, Wiater JM, Pfaff HC, Bigliani LU, Levine WN. Detection of acromioclavicular joint pathology in asymptomatic shoulders with magnetic resonance imaging. J Shoulder Elbow Surg 2001;10:204-8.  https://doi.org/10.1067/mse.2001.113498
  7. Aly AR, Rajasekaran S, Ashworth N. Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: a systematic review and meta-analysis. Br J Sports Med 2015;49:1042-9.  https://doi.org/10.1136/bjsports-2014-093573
  8. Javed S, Sadozai Z, Javed A, Din A, Schmitgen G. Should all acromioclavicular joint injections be performed under image guidance. J Orthop Surg (Hong Kong) 2017;25:2309499017731633. 
  9. Park KD, Kim TK, Lee J, Lee WY, Ahn JK, Park Y. Palpation versus ultrasound-guided acromioclavicular joint intra-articular corticosteroid injections: a retrospective comparative clinical study. Pain Physician 2015;18:333-41. 
  10. Sabeti-Aschraf M, Lemmerhofer B, Lang S, et al. Ultrasound guidance improves the accuracy of the acromioclavicular joint infiltration: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2011;19:292-5.  https://doi.org/10.1007/s00167-010-1197-y
  11. van Riet RP, Bell SN. Clinical evaluation of acromioclavicular joint pathology: sensitivity of a new test. J Shoulder Elbow Surg 2011;20:73-6.  https://doi.org/10.1016/j.jse.2010.05.023
  12. Krill MK, Rosas S, Kwon K, Dakkak A, Nwachukwu BU, McCormick F. A concise evidence-based physical examination for diagnosis of acromioclavicular joint pathology: a systematic review. Phys Sportsmed 2018;46:98-104.  https://doi.org/10.1080/00913847.2018.1413920
  13. Larson HM, O'Connor FG, Nirschl RP. Shoulder pain: the role of diagnostic injections. Am Fam Physician 1996;53:1637-47. 
  14. Tallia AF, Cardone DA. Diagnostic and therapeutic injection of the shoulder region. Am Fam Physician 2003;67:1271-8. 
  15. Petersson CJ. Painful shoulders in patients with rheumatoid arthritis: prevalence, clinical and radiological features. Scand J Rheumatol 1986;15:275-9.  https://doi.org/10.3109/03009748609092592
  16. Neer CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am 1972;54:41-50.  https://doi.org/10.2106/00004623-197254010-00003
  17. Chronopoulos E, Kim TK, Park HB, Ashenbrenner D, McFarland EG. Diagnostic value of physical tests for isolated chronic acromioclavicular lesions. Am J Sports Med 2004;32:655-61.  https://doi.org/10.1177/0363546503261723
  18. O'Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med 1998;26:610-3.  https://doi.org/10.1177/03635465980260050201
  19. Alghadir AH, Anwer S, Iqbal A, Iqbal ZA. Test-retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. J Pain Res 2018;11:851-6.  https://doi.org/10.2147/JPR.S158847
  20. Berendes T, Pilot P, Willems J, Verburg H, te Slaa R. Validation of the Dutch version of the Oxford Shoulder Score. J Shoulder Elbow Surg 2010;19:829-36.  https://doi.org/10.1016/j.jse.2010.01.017
  21. Dawson J, Fitzpatrick R, Carr A. Questionnaire on the perceptions of patients about shoulder surgery. J Bone Joint Surg Br 1996;78:593-600.  https://doi.org/10.1302/0301-620X.78B4.0780593
  22. van de Water AT, Shields N, Davidson M, Evans M, Taylor NF. Reliability and validity of shoulder function outcome measures in people with a proximal humeral fracture. Disabil Rehabil 2014;36:1072-9.  https://doi.org/10.3109/09638288.2013.829529
  23. Yang Q, Lu W, You T, Zhang X, Zhang W, Li C. Effectiveness of arthroscopic distal clavicle resection for symptomatic acromioclavicular joint arthritis. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2022;36:698-702. 
  24. Freedman BA, Javernick MA, O'Brien FP, Ross AE, Doukas WC. Arthroscopic versus open distal clavicle excision: comparative results at six months and one year from a randomized, prospective clinical trial. J Shoulder Elbow Surg 2007;16:413-8.  https://doi.org/10.1016/j.jse.2006.10.006
  25. Gwilym SE, Pollard TC, Carr AJ. Understanding pain in osteoarthritis. J Bone Joint Surg Br 2008;90:280-7.  https://doi.org/10.1302/0301-620X.90B3.20167
  26. Lewis GN, Rice DA, McNair PJ. Conditioned pain modulation in populations with chronic pain: a systematic review and meta-analysis. J Pain 2012;13:936-44. https://doi.org/10.1016/j.jpain.2012.07.005