Short- and medium-term outcomes of patients with subacromial-subdeltoid bursitis following ultrasound-guided corticosteroid injection: a prospective single-group cohort study

Abstract

RESEARCH QUESTIONS: (1) What are the clinical outcomes of patients receiving a corticosteroid injection into the SASD bursa for SASD bursitis

(2) If patients return to their referring rehabilitation provider following the injection, how does this affect their outcomes compared to those that do not return?

3) If patients are prescribed rehabilitative exercises by their referring rehabilitation provider, how does adherence to these exercises affect their outcome?

ABSTRACT:

BACKGROUND: Shoulder pain is among the most common musculoskeletal complaints, and subacromial impingement syndrome (SIS) is the most common cause. The subacromialsubdeltoid (SASD) bursa can become irritated and inflamed in SIS, leading to a diagnosis of SASD bursitis. Corticosteroid injection (CSI), manual therapy and rehabilitative exercises are common treatment options for shoulder pain. Manual therapy and rehabilitative exercises may be useful in the period of short-term pain relief following CSI. For SASD bursitis, it is relatively unknown to what extent CSI and subsequent manual therapy and rehabilitative exercises affect outcomes. Therefore, this study aimed to establish the clinical outcomes of patients after receiving a single CSI into the SASD bursa for SASD bursitis and to investigate how returning to a rehabilitation provider and being adherent to rehabilitative exercises postinjection affects outcomes.

METHODS: A total of 64 participants diagnosed with SASD bursitis by a sonographer based on ultrasound imaging received an ultrasound-guided injection of corticosteroid and local anaesthetic into the SASD bursa. The recruitment period was 2 February until 21 May 2019. Participants completed questionnaires at pre-injection and at time intervals of 3-5-days, 3- weeks and 3-months post-injection. The Shoulder Pain and Disability Index (SPADI) was the primary outcome measure while the Pain and Sleep Questionnaire three-item index (PSQ-3) was the secondary outcome measure. The Exercise Adherence Rating Scale (EARS) was used to obtain information on participants adherence to rehabilitative exercises.

RESULTS: There were statistically significant decreases in SPADI scores 3-5-days (p≤0.001), 3-weeks (p≤0.001) and 3-months (p≤0.001) post-injection. There were also statistically significant decreases in PSQ-3 scores 3-5-days (p≤0.001), 3-weeks (p≤0.001) and 3-months (p = 0.001) post-injection. The difference in SPADI scores at the3-month follow-up between those participants who returned to a rehabilitation provider and those who did not was not.