Clinical Inquiries

Does ultrasound guidance improve outcomes for steroid joint injections?

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EVIDENCE-BASED ANSWER

A Patients yes, at least in the short term. Ultrasound-guided (USG) injections of triamcinolone into the shoulder improve function more than palpation-guided (PG) steroid injections over 6 weeks (strength of recommendation [SOR]: B, 2 small randomized, controlled trials [RCTs]).

USG steroid injections are also less painful than PG injections (SOR: A, multiple RCTs). They reduce pain more than PG injections in arthritic joints (shoulder, elbow, wrist, hand, hip, knee, or ankle) over 2 weeks (SOR: B, lower quality RCTs with some inconsistent results) but possibly not at 6 weeks (SOR: B, multiple RCTs with conflicting results).

EVIDENCE SUMMARY

A prospective RCT found that USG steroid joint injections improved shoulder function more than PG injections in patients with shoulder pain unresponsive to nonsteroidal anti-inflammatory drugs (NSAIDs).1 Investigators randomized 60 patients (mean age 52.5 years) to either USG or PG injections of triamcinolone 40 mg given by a rheumatologist. They used a 10-point visual analog scale (VAS) to assess pain and evaluated joint function at 6 weeks using a validated 100-point scale for shoulder function,2 with high scores indicating better function.

The USG group showed greater improvement from baseline in pain (TABLE)1,3-7 and function scores than the PG group (32 vs 12 points; P<.05).1 Investigators didn’t control for a possible placebo effect from ultrasound in this trial (or any trial described here). Another RCT found that USG steroid joint injections improved shoulder function more than PG injections in patients with rheumatoid arthritis and at least one month of shoulder pain unresponsive to NSAIDs.3 Investigators randomized 41 rheumatology clinic patients (mean age 52.4 years) to USG or PG injections of 20 mg triamcinolone.

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