Accuracy of Landmark-guided Glenohumeral Joint Injections as Assessed by Ultrasound in Anterior Shoulder Dislocations

Omer, Talib; Perez, Michael Francis; Berona, Kristin; Lam, Chun Nok; Sajed, Dana; Brandon, Caroline; Falkenstein, Jeffrey; Kang, Tarina L.; Mailhot, Thomas

doi:10.5811/westjem.2021.3.50266

Cited by 6 publications

(7 citation statements)

References 26 publications

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“…We also found no differences in complications between the techniques. Our results were consistent with previous research indicating that an intra-articular lidocaine injection is safe with a low risk of neurovascular injury [12,18]. However, although previous articles support the idea that the risks of infection and chondrolysis are low [5,6,8,14], we cannot definitively state this because both complications typically occur after an extended amount of time, and our study only had a 2-week follow-up period.…”

Section: Length Of Stay In the Emergency Department And Complicationssupporting

confidence: 91%

Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial

Rungsinaporn,

Innarkgool,

Kongmalai

2023

Clin Orthop Relat Res

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Background Effective pain control during reduction of shoulder dislocation is essential for patient comfort. However, there is a lack of comprehensive research comparing the efficacy of different pain management techniques, specifically landmark-guided and ultrasound-guided intra-articular analgesic injections. Questions/purposes Among patients undergoing closed reduction of a shoulder dislocation, were there differences between an intra-articular shoulder injection placed using anatomic landmarks and an ultrasound-guided intra-articular injection in terms of (1) pain before versus after the injection and pain before injection versus after the reduction, or (2) length of stay in the emergency department and complications of the procedure? Methods Between August 2021 and March 2023, 28 patients with anterior shoulder dislocation were treated at the emergency department of a tertiary referral care center. They were randomly assigned to either the landmark-guided or ultrasound-guided intra-articular lidocaine injection group. Differences in pain levels between preinjection and postinjection, preinjection and postreduction, length of hospital stay, and complications were assessed and compared between the two groups. Patients were followed for 2 weeks. Results There were no between-group differences in terms of age, gender, baseline pain score, and any other relevant factors. There were no differences between the groups in terms of pain reduction between preinjection and postinjection (landmark-guided: ΔVAS 2.8 ± 1.1, ultrasound-guided: ΔVAS 2.9 ± 1.0, mean difference -0.14 [95% confidence interval -0.97 to 0.68]; p = 0.72) or between preinjection and postreduction (landmark-guided: ΔVAS 6.6 ± 2.1, ultrasound-guided: ΔVAS 5.8 ± 1.8, mean difference 0.79 [95% CI -0.74 to 2.31]; p = 0.30). There were no differences in length of stay in the emergency department (landmark-guided: 162 ± 38 minutes, ultrasound-guided: 184 ± 73 minutes, mean difference 22 minutes [95% CI -67 to 24]; p = 0.33), and no complications were reported in either group during the 2-week follow-up period. Conclusion The results of the landmark-guided technique were not different from those of ultrasound-guided injection in terms of lower pain levels, length of stay, and complications. These findings provide valuable guidance for orthopaedic surgeons, enabling them to make informed decisions based on their expertise and available resources. Level of Evidence Level I, therapeutic study.

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Section: Length Of Stay In the Emergency Department And Complicationssupporting

confidence: 91%

Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial

Rungsinaporn,

Innarkgool,

Kongmalai

2023

Clin Orthop Relat Res

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“…This might be because IAA may not have been administered appropriately. A previous study reported that landmark‐guided IAA administered local anesthetics to inappropriate points in 41.1% of cases, as assessed using ultrasound 31 . Moreover, ultrasound‐guided IAA can be used to administer local anesthetics to the appropriate point 31 .…”

Section: Discussionmentioning

confidence: 99%

“…A previous study reported that landmark‐guided IAA administered local anesthetics to inappropriate points in 41.1% of cases, as assessed using ultrasound 31 . Moreover, ultrasound‐guided IAA can be used to administer local anesthetics to the appropriate point 31 . Therefore, under conditions of adequate pain relief, the IAA method has the potential to achieve a lower pain score than that of the IVS method.…”

Section: Discussionmentioning

confidence: 99%

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Comparative efficacy of sedation or analgesia methods for reduction of anterior shoulder dislocation: A systematic review and network meta‐analysis

Hayashi

Kano

Yamamoto

et al. 2022

Academic Emergency Medicine

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Background:We performed a network meta-analysis (NMA) to compare the efficacy and safety of intravenous sedation (IVS), intraarticular anesthetic injection (IAA), and peripheral nerve block (PNB) as sedation or analgesia methods for the reduction of anterior shoulder dislocation. Methods:We included randomized controlled trials (RCTs) comparing different sedation or analgesia methods for anterior shoulder dislocation reduction. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, ICTRP, Clini calTr ials.gov, and Google Scholar databases were searched in October 2021. We conducted a random-effects NMA within a frequentist framework. We evaluated the confidence in each outcome using the CINeMA tool.Results: Sixteen RCTs (957 patients) were included. Regarding the primary outcomes, the three methods might result in little to no difference in the immediate success rate of reduction and patient satisfaction. The IAA method had a shorter emergency department length of stay than that of the IVS method (mean difference [MD] −107.88 min, 95% confidence interval [CI] −202.58 to −13.18). In the secondary outcomes, the IAA method had a lower pain score than that of the PNB method (standardized MD −1.83, 95% CI −3.64 to −0.02). The IAA and PNB methods might require a longer time for reduction than that of the IVS method (MD 5.3 min, 95% CI 2.4 to 10.36; MD 15.25, 95% CI 5.49 to 25.01). The three methods might result in little to no difference in the number of reduction attempts and total success rate of reduction. However, the confidence ratings for all treatment comparisons were very low. IAA and PNB had no adverse respiratory events. Conclusions:The results of our NMA indicated that three sedation or analgesia methods (IVS, IAA, and PNB) might result in little to no difference in the success rate of reduction and patient satisfaction. IAA and PNB had no adverse respiratory events.

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“…It was not reported if this was because they were old and at high risk for drugs use or because of ED overcrowding. A previous study showed that landmark‐guided shoulder joint injections were misplaced in 41.1% of cases by EPs [ 18 ]; the success rate of the interscalene brachial plexus nerve block by EPs was 71% [ 19 ]; shoulder dislocation reduction required a moderate depth of sedation [ 20 ]. Our study did not record pain score and sedation depth, although the 15 patients who used sedatives or analgesics may have had inadequate pain relief or sedation.…”

Section: Discussionmentioning

confidence: 99%

Success rate of anterior shoulder dislocation reduction by emergency physicians: a retrospective cohort study

Hayashi

Tanizaki

Nishida

et al. 2022

Acute Medicine & Surgery

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Aim Emergency physicians (EPs) often treat anterior shoulder dislocation, but epidemiology of anterior shoulder dislocation in the emergency department of Japan remains unclear. In this study, we clarified the success rate of anterior shoulder reduction performed by EPs. Methods This single‐center cohort study included patients with anterior shoulder dislocation for whom the EP performed initial reduction. The period was from January 2006 to March 2021 and we used the electronic medical record data of the tertiary care hospital. Our primary outcome was the success rate of the shoulder reduction performed by EP. The secondary outcome was to compare the success of reduction with the failure of the reduction. Results In total, 293 eligible patients were identified. Of these patients, 244 were included in this study. The success rate of the shoulder reduction performed by EP was 92.2% (225/244). EPs failed in successfully performing reduction in 19 (7.8%) cases of anterior shoulder dislocations. The failure group was older ( P = 0.017), had a higher frequency of fall down in the mechanism of dislocation ( P = 0.019), used intravenous analgesics more frequently ( P = 0.004), used peripheral nerve blocks more frequently ( P = 0.006), and had fewer patients who did not use drugs ( P = 0.002). We could not perform statical adjustment because the sample size was small. Conclusion The success rate of the shoulder reduction performed by EPs was 92.2%. Older age might be associated with failure of shoulder reduction.

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Accuracy of Landmark-guided Glenohumeral Joint Injections as Assessed by Ultrasound in Anterior Shoulder Dislocations

Cited by 6 publications

References 26 publications

Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial

Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial

Comparative efficacy of sedation or analgesia methods for reduction of anterior shoulder dislocation: A systematic review and network meta‐analysis

Success rate of anterior shoulder dislocation reduction by emergency physicians: a retrospective cohort study

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