Biologic Orthopedic Society

What is the consensus among the group for the composition of an injection for subacromial impingement? Also, please see this newly published article:http://www.ncbi.nlm.nih.gov/pubmed/23177167

A double-blind randomized controlled trial comparing the effects of...ncbi.nlm.nih.gov

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hace 2 días

5 comentarios

Seguir a Carlos

Carlos Molano-Bernardino • Interesting absatract!!
I have usually seen subacromial injections as part of a diagnostic proceeding ( Neer test) looking forward indication for surgery.
A few times I have used them for symptomatic treatment.
regarding tht paper NSAIDS seems to b better. I will consider its use next patient, specially if he/she is diabetic.

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Seguir a Scott

Scott Nall, DO • Because of the discussions on this forum I've been lowering my steroid concentration of bursa injections to rediculously small amounts and still getting good results. What the abstract didn't mention was were they injecting the NSAID into the bursa or just IM

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Seguir a Allan

Allan Mishra • Scott: I think it was injected in the subacromial bursa but I am not sure. I have not seen the full article. I just sent the lead author an email asking him to clarify for us. I also asked him to join the group and comment directly if interested. I'll post any response here. Good question for us to have answered. Allan

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WilliamDejar de seguir

William Murrell • Hi Allan, thanks for the post. Since your original post for SAI a few months back, and the very helpful feedback from you and Chris. I have totally changed the composition of my subacromial injections, and for that matter all injections about the shoulder. I am working on completing a retrospective study correlating history, physical exam, imaging, functional testing with arthroscopic findings in 100 consecutive arthroscopic shoulders. Without going into the fine details.....one of the obvious findings was that the shoulder exam tests, including injection tests retrospectively were poor to fair in predicting surgical shoulder lesions. With this in mind, I have started to throw conventional thinking out of the window or correlating imaging with physical findings......and have just started injecting all the possible areas. I feel that I can do this with impunity, because of the doses that Chris suggested.....400ng......and I usually start with an US guided injection of the GHJ first....even if I think it is impingment. What is so funny, I was chatting with Dr. John Bergfeld at the conference last week about this topic, he actually quizzed me about where the shoulder injection should be done......and he feels exactly the same way...except he used 40mg. I see quite a few AC/FS as well, and I give them the same dose, and just repeat as needed. Patients are pretty happy, the diabetics do not get a jump in their blood glucose....all are happy. Big thanks to Chris, low dose CS, high volume injections seem to do the trick. Of course a MC DB RCT would be better.....any takers...happy to include our center.....maybe 4 groups------NS vs HD CS vs LD CS vs NSAID. Cheers. Bill

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Seguir a Marco

Marco Ferraresi • Hi Allan,i use 3 cc of Lidocaina with 40mg of Triamcinolone. In diabetc patients too.
with great satisfaction. usually.
In Italy i can't use Ketorolac for subacromial injection because this use is off label.

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