Systematic review and meta-analysis on the effectiveness of ultrasound-guided versus landmark corticosteroid injection in the treatment of shoulder pain: an update

Abstract

Background Corticosteroid (CS) can be injected in a blind fashion (landmark-guided) or with ultrasound (US) guidance, and this may contribute to varying clinical results. We conducted this systematic review and meta-analysis to assess the effectiveness of US-guided versus landmark CS injections in the treatment of adult patients with shoulder pain. Methods We searched MEDLINE (via PubMed), Scopus, Web of Science, EBSCO, and Cochrane Library for randomized controlled trials (RCTs) comparing US-guided versus landmark CS injection regarding visual analogue scale (VAS), functional scores, disability scores, abduction degree, and side effects. The data were pooled as mean difference (MD), standardized mean difference (SMD), or risk ratios (RRs), with 95% confidence intervals (CIs), using R software (meta package 4.9-0) for windows. Subgroup analysis and leave-one-out analysis were conducted. Results Eighteen RCTs, with a total of 1010 patients, were included in this meta-analysis. The pooled estimate favored the US-guided over landmark CS injection in terms of the mean change of VAS between 6 weeks and baseline (SMD = − 0.48, 95% CI [− 0.79, − 0.17]), the shoulder functional scores (SMD = 0.35, 95% CI [0.05, 0.65]) and shoulder abduction degree (MD = 8.78, 95% CI [3.11, 14.46]). Whilst no significant difference was found between the compared group regarding the overall shoulder disability scores (SMD = − 0.51, 95% CI (− 1.25, 0.22]) and side effects (RR = 0.45, 95% CI [0.15, 1.34]). None of the eligible study analyzed the cost-effectiveness of the US-guided method compared with the landmark method for CS injection. Conclusion Our analysis showed that US-guided CS injection was effective in the treatment of various shoulder diseases. Further research on the cost-effectiveness of US-guided CS methods is needed.

Comparison of ultrasound guidance with landmark guidance for symptomatic benefits in knee, hip and hand osteoarthritis: Systematic review and meta‐analysis of randomised controlled trials

“…26 Similar to this meta-analysis, a 2023 systematic review in shoulder pain comparing the two techniques demonstrated a significant reduction in pain [SMD À0.48, 95% CI (À0.79, À0.17)] and functional improvement [SMD 0.35, 95% CI (0.05, 0.65)], favouring the ultrasound-guided injection. 27 In a 2018 narrative review related to ultrasound-guided injection in sports medicine, superior clinical outcomes were noted for the glenohumeral joint, the subacromial space, the biceps tendon sheath and the joints of the hand and wrist, the knee, ankle and foot. 28 In addition to the difference in clinical outcomes between the two techniques, our meta-analysis also demonstrated the significant difference in procedure-related pain which is important for patient's acceptability.…”

The use of corticosteroid injection in the treatment of chronic shoulder pain.

“…Though it ranks third in orthopedic practice, shoulder pain is a prominent cause of musculoskeletal discomfort. 1 Shoulder discomfort is a common, functionally crippling condition affecting people of all ages and activity levels, with the main cause being Subacromial Impingement Syndrome (SIS). 2 Adhesive capsulitis, shoulder instability, arthritis, and rotator cuff disorderswhich can include tendinopathy, partial tears, and total tears-are some of the illnesses that can cause persistent shoulder discomfort.…”