Glenohumeral Injection Using Anatomic Landmark Versus Sonographic Needle Guidance

Objective: We hypothesized ultrasound (US) guidance improves outcomes of corticosteroid injection of the painful shoulder.Methods: 30 patients with symptomatic shoulders due to osteoarthritis were randomized to glenohumeral injection with 3 milliliters of 1% lidocaine and 60 mg of triamcinolone acetonide using the anterior approach with 1) conventional anatomic landmark palpation-guidance or 2) US-guidance. Injection pain (visual analogue pain scale (VAS)), pain at outcome (2 weeks and 6 months), therapeutic duration, time-to-next-injection, and costs were determined.Results: Injection pain was less with US (VAS: 0.3 (0.6) cm) vs. landmark-guidance (VAS: 1.4 (2.4) cm, 95% CI of difference: 0.5u003c1.1u003c1.7, p=0.05). Pain scores were similar at 2 weeks: US: 2.2 (2.4) cm; Landmark: 1.8 (2.7) cm, 95% CI of difference: -2.2u003c-0.4u003c1.4, p=0.66 and 6 months: US: 5.8 (2.8) cm; Landmark: 6.4 (2.9) cm, 95% CI of difference: -0.4u003c0.6u003c 1.1, p =0.71. Therapeutic duration (US: 3.9 (1.5) months; Landmark: 3.0 (1.2) months, 95% CI of difference: -1.4 u003c-0.9u003c-0.4, p=0.045) and time to next injection (US: 8.1 (3.5) months; Landmark: 5.7 (2.9) months, 95% CI of difference: -3.6u003c-2.4u003c-1.3, p=0.025) were longer, and fewer injections per year (29% less) were required: US: 1.5 (0.2) injections/year; Landmark: 2.1 (0.2) injections/year (pu003c0.037; 95% CI of difference -0.9u003c-0.6u003c-0.3). However, cost/patient/year was modestly greater with US (US: $318 (89), Landmark: $301 (67); p=0.28).Conclusion: Anatomic landmark guidance in the short-term is equally effective as US for injection of the osteoarthritic shoulder and modestly less costly, however, US may reduce the need for repetitive injections by prolonging the therapeutic effect and thus time to next injection.Clinical trial registration ID #NCT00651625