The level of evidence is downgraded because of study quality (inadequate allocation concealment and blinding).
A Cochrane review [Abstract] 1 included 5 studies with a total of 290 subjects. The image-guided groups in all trials used ultrasound to guide injection. Four studies included participants with rotator cuff disease; in three the comparator was local landmarks to direct injection into the subacromial bursa and in the fourth the comparator was systemic intramuscular injection into the upper gluteal muscles in the buttock region. One study included participants with adhesive capsulitis and injection was directed into the glenohumeral joint by either ultrasound or anatomical landmark guidance.
No significant differences between groups were observed with respect to reduction in pain at one to two weeks (two trials, 146 participants, SMD -1.44, 95% CI -4.14 to 1.26), or function at one to two weeks (two trials, 146 participants, SMD 0.95, 95% CI -1.29 to 3.20; back-translated to mean difference (MD) 4 points, 95% CI -5 to 13, on a 0 to 100 point scale, higher score means better function) or six weeks (three trials, 207 participants, SMD 0.63, 95% CI -0.06 to 1.33; back-translated to MD -3 points, 95% CI -11 to 5, on a 0 to 100 point scale). No statistical difference in adverse events between groups was identified (10/104 image-guided group versus 16/103 comparator; RR 0.55, 95% CI 0.17 to 1.85). Minor adverse events reported included transient post-injection pain, facial redness and warmth.
Date of latest search: 2011-11-14
Primary/Secondary Keywords