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KMID : 1195520120050010009
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Journal of Korean Orthopaedic Ultrasound Society
2012 Volume.5 No. 1 p.9 ~ p.14
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Accuracy and Clinical Outcomes of Ultrasound-guided Glenohumeral joint Injection: Acromioclavicular Approach in Patients with Adhesive Capsulitis
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Lee Sang-Hoon
Hwang Seok-Min
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Abstract
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Purpose: The purpose of the study was to evaluate the accuracy and clinical outcome of ultrasound-guided glenohumeral joint steroid injection on adhesive capsulitis.
Materials and Methods: Patients who were diagnosed as adhesive capsulitis by MRI and physical examination and did not improve their symptom with physical therapy and NSAIDS treatment more than 6 months were included in the study. Patients who showed any other shoulder pathology or history if trauma were excluded from the study. 33 patients including 15 males and 18 females were enrolled in the study, the average age being 55.1 (age 42~72).
Cocktail of steroid, lidocaine, saline and contrast medium injected inside shoulder glenohumeral joint using novel approach (which we called acromioclavicular approach) under ultrasound guidance. Clinical outcome was measured through passive range of motion and VAS scoring system.
Results: Based on radiographic findings, cases were classified according to the leakage of contrast medium; perfect confinement of contrast-medium inside the capsule, partial leakage of the medium and contrast-medium found at outside the joint. Total 25 cases (76%) out of 33 cases showed perfect confinement of contrast-medium inside the glenohumeral joint. Partial leakage was observed in 6 cases (18%), and contrast medium was observed outside of the
glenohumeral joint in 2 cases (6%). Perfect-confinement group showed 111??(80~140??) of forward flexion and 48??
(0~90??) of external rotation before injection, and improved to 134??(90~150??) of forward flexion and 70??(30~90??) of
external rotation after injection (p<0.01). Partial leakage showed 120??(90~150??) of forward flexion and 70??(10~90??) of
external rotation before injection, and improved to 139??(135~140??) of forward flexion and 78??(50~90??) of external
rotation after injection (p<0.01). VAS score improved from 7.1 (score 3~9) to 2.6 (score 0~5) (p<0.01) in perfect confinement group, from 7.5 (score 7~9) to 3.3 (score 2~4) (p<0.01) in partial leakage group. Two group showed no significant difference.
Conclusion:Accuracy of Acromioclavicular approach was 94% which is better than any other methods published so far. Partial leakage of the injection material did not show inferior result compared to perfect injection.
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KEYWORD
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Adhesive capsulitis, Acromioclavicular approach, Injection into glenohumeral joint
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