Should we continue to administer blind shoulder injections?
Mehmet Ağırman1, Merve Akdeniz Leblebicier2, Oğuz Durmuş1, İlknur Saral1, Osman Hakan Gündüz2
1Department of Physical Medicine and Rehabilitation, Medical Faculty of İstanbul Medipol University, İstanbul, Turkey
2Department of Physical Medicine and Rehabilitation, Medical Faculty of Marmara University, İstanbul, Turkey
Keywords: Injection; intra-articular; pain; shoulder.
Objectives: This study aims to investigate the accuracy and effectiveness of blind and fluoroscopic-guided intra-articular shoulder injections in patients with shoulder pain.
Patients and methods: The study included 17 patients (6 males, 11 females; mean age 52.6±9.9 years; range 36 to 66 years) with shoulder pain more than three months. First intra-articular joint injections were performed with anterior approach blindly. Following the injection and after confirming that the needle tip was intra-articular with fluoroscopy and contrast distribution, the procedure was completed using 3 mL of local anesthetic (prilocaine and bupivacaine) and 1 mL of steroid (40 mg methylprednisolone). When the contrast distribution was observed to be extra-articular at the first administration, a second injection was continued under fluoroscopy guidance. All of the injections were intraarticular with the continuation of the procedure. Pain intensity was measured with visual analog scale (VAS).
Results: According to the contrast distribution viewed with fluoroscopy, first blind injections were intra-articular in 11 of the 17 shoulders (64.7%). Mean of initial VAS score was 7.11. Improved pain was observed in the clinical follow-ups at the first hour (mean VAS: 2.35), third day (mean VAS: 2.64), and at the end of the first month (mean VAS: 2.23). The mean durations for blind and fluoroscopic-guided procedures excluding patients’ preparation time were 0.8 minutes and 4.2 minutes, respectively.
Conclusion: Although blind intra-articular shoulder injections are inexpensive and easily applicable, injections should be performed under fluoroscopy or another guide to ensure that the needle is intra-articular, not peri-articular.