SHOULDER & ELBOW
Image-guided versus blind corticosteroid injections in adults with shoulder pain: a systematic review
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(5):28 BMC Musculoskelet Disord. 2011 Jun 25;12:137. doi: 10.1186/1471-2474-12-137Findings of two randomized controlled trials were pooled in order to investigate if method of corticosteroid injection - either image-guided or anatomical landmark guided (blind) - impacted clinical outcome in patients suffering from shoulder pain. Clinical outcomes of pain and function were reported at 6 weeks, and the incidences of adverse events were recorded. Pooled effects illustrated that pain and function at 6 weeks were significantly improved with image-guided injections compared to blind injections. Incidence of adverse events was also lower in image-guided group; however, the difference did not reach statistical significance.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
Ja = 1
Ungewiss = 0.5
Nicht relevant = 0
Nein = 0
Die Bewertung der Berichtskriterien bewertet die Transparenz, mit der die Autoren die methodischen und studienspezifischen Merkmale der Studie in der Veröffentlichung angeben. Die Bewertung ist in fünf Kategorien unterteilt, die im Folgenden vorgestellt werden.
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Introduction
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Accessing Data
4/4
Analysing Data
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Results
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Der Fragilitätsindex ist ein Instrument, das bei der Interpretation signifikanter Ergebnisse hilft und ein Maß für die Stärke eines Ergebnisses liefert. Der Fragilitätsindex gibt die Anzahl der aufeinanderfolgenden Ereignisse an, die zu einem dichotomen Ergebnis hinzugefügt werden müssen, damit das Ergebnis nicht mehr signifikant ist. Eine kleine Zahl steht für ein schwächeres Ergebnis und eine große Zahl für ein stärkeres Ergebnis.
Warum wurde diese Studie jetzt benötigt?
Shoulder pain of a number of etiologies is commonly treated with injection of corticosteroid. Injections can be performed "blindly", using anatomical landmarks for guidance, or image guidance can be used for guidance, usually with ultrasound. Although studies have reported that image guidance does lead to higher injection accuracy, there are conflicting reports about whether or not higher accuracy is translated into more improved outcome compared to blind injection. Therefore, this study was designed to assess clinical outcome of patients treated with either blind or image-guided injection.
Was war die wichtigste Forschungsfrage?
Did image-guided injection of corticosteroid lead to improved clinical outcome, primarily pain, and function when compared to landmark-guided injection?
Was waren die wichtigsten Ergebnisse?
- Two studies were selected for inclusion, both of which reported pain, function, and adverse events experienced.
- Pain outcome (VAS 0-10) at 6 weeks was significantly improved with image-guided injection compared anatomical landmark guidance (SMD 2.23 (95%CI 1.27-3.18), p<0.00001) (I-squared = 61%).
- Functional outcome was assessed by either the Constant Score of the Shoulder Function Assessment Scale. Pooled effect resulted in significant improvement at 6 weeks with the use of image guidance compared to blind injection (SMD 1.09 (0.61-1.57), p<0.00001) (I-squared = 22%).
- Incidence of mild adverse events was lower when image-guided injection was performed (RR 0.20 (0.04-1.13)), however the difference did not reach statistical significance (p=0.07). Heterogeneity was not observed (I-squared = 0%). Time-frame of which adverse events were recorded was not reported.
Was sollte ich mir besonders merken?
Image-guidance of corticosteroid injection in shoulder pain treatment was associated with a significant improvement in pain and function at 6 weeks compared to blind injection. A lower incidence of adverse events was also associated with image-guided injection, however the difference was not statistically significant.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
The findings of this analysis suggest that improved clinical outcomes may be attained with an ultrasound- or fluoroscopy-guided injection of corticosteroid when treating shoulder pain. Since the number of studies included in this analysis was rather low (only 2), as well the noted heterogeneity in the pain outcome analysis, more trials investigating this comparison are needed to either substantiate or refute these findings, and to ultimately conclude on injection guidance efficacy.
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