Functional outcome of subacromial injection of corticosteroid mixed with local anesthestic for management of shoulder impingement syndrome
Qazi Waris Manzoor MS, Tabish Tahir Kirmani MS, Khurshid Ahmad Kangoo MS
Introduction: Shoulder Impingement is a common cause of shoulder pain. The concept of the impingement syndrome was popularized by Neerwho described a clinical test involving maximal passive forward elevation of the shoulder, known as the Neer impingement sign.Once diagnosed, the initial therapy for subacromial impingement syndrome is nonsurgical, and may include modification of activities, analgesic nonsteroid anti-inflammatory drugs, cryotherapy, ultrasound, electromagnetic radiation, corticosteroid injection and physical therapy. In this study we evaluate the short term functional outcome of subacromial injection of corticosteroids and local anesthesia for the treatment of painful subacromial impingement syndrome. Methods: Ninety six patients with shoulder pain characteristic of subacromial impingement syndrome were included in the study from 2015 to 2019. We had 59 males and 37 females. The mean age in this study was 56.5 years (range 32-69 years). Sixty nine patients had right sided involvement (all dominant) and 27 patients had left sided involvement. The mean duration of symptoms prior to injection was 5.6 months (range 2-14 months). Functional status was assessed using the Constant score, pain was assessed using a visual analog scale, and range of motion was measured with a goniometer. Each qualified patient was given an injection of 2 ml tricort (80mg triamcinolone) and 2ml of 2% Xylocaine suspension with a 21-gauge needle into the subacromial space with a standardized posterolateral approach. A reduction of pain with increased active abduction after injection clinically confirmed accurate placement. At the 4-week visit, the Constant score, visual analog scale for pain, and range of motion were reassessed. Results: Eighty five patients achieved improvement in the amount of pain and range of motion. The mean improvements in the active range of motion of forward flexion, abduction, internal rotation and external rotation were 54°, 34°, 16° and 19°, respectively. The total Constant’s scores were 44 before injection and 79.6 after injection.