DOES ULTRASONOGRAPHY GUIDED STEROID INJECTIONS PROVIDE BETTER OUTCOME IN SHOULDER IMPINGEMENT SYNDROME? A PROSPECTIVE STUDY

Shoulder pain is the third most common musculoskeletal complaint in orthopedic practice and impingement syndrome is one of the more common underlying diagnosis(1). Neers classification system is used as a criteria for diagnosis. The affected patients are generally over age 40(1). Patients present with pain on elevating the arm or when lying on the affected side. Individuals will often present with complaints of pain upon lifting the arm or with lying on the affected side. They may report loss of motion as the primary reason they come in to be evaluated, or that nighttime pain prevents them from sleeping. Weakness and stiffness often result secondary to the pain(1,2). The decision to treat conservatively or surgically is generally made on the basis of the duration and severity of pain, the degree of functional disturbance, and the extent of structural damage. The goal of treatment is to restore pain-free and powerful movement of the shoulder joint.(1) There is a wide variety of conservative treatments for SIS ranging from different physiotherapy modalities such as joint mobilisation techniques and strengthening exercises, adaptations of daily activities, non-steroidal anti-inflammatory drugs (NSAIDs) as well as steroid injections(4). Subacromial corticosteroid injection (CSI) is a popular SIS treatment method amongst orthopaedists, rheumatologists and general practitioners(5). This method is regarded as an inexpensive and effective way to both diagnose and treat symptomatic rotator cuff disease and SIS (6). Therapeutic effects of CSI on pain, inflammation and range of motion (ROM) have mostly been observed as being limited to a short-term effect (7). It is important to increase the accuracy rate of the steroid injection to get a better clinical outcome in relieving pain and improving function. This study intends to find out the superiority of USG guided subacromial steroid injection over landmark guided subacromial steroid injection in shoulder impingement syndrome. Objective of the study- To compare the difference between Ultrasound guided and landmark guided steroid injection , with the hypothesis that ultrasound guided injection technique has superior outcome. Methods It is an observational clinical study, carried out at a Tertiary Hospital MGM Medical college at Navi Mumbai between July 2021 and December 2021 for 6 months duration, which included 100 patients showing signs and symptoms of shoulder impingement syndrome. Patient were categorized into ultrasound guided subacromial steroid injection group and landmark guided subacromial steroid injection group. Written and informed consent was taken from each patient willing to be enrolled in the study. A 2 weekly, 4 weekly and 6 weekly follow up post treatment was done on an OPD basis . During each visit patients evaluation was done using SPADI (shoulder pain and disability index) score. Conclusion Improvement of shoulder function and pain was statistically significant in Ultrasound guided subacromial steroid injection as compared to landmark guided subacromial steroid injection. Therefore functional outcome of ultrasound guided subacromial steroid injection is better than landmark guided subacromial steroid injection.