Search Our Scientific Publications & Authors

Clin J Sport Med 2019 Feb 13. Epub 2019 Feb 13.

School of Public Health, University of Sydney, Sydney, Australia.

Background: The use of local anesthetic painkilling injections to improve player availability is common practice in elite-level sport.

Objective: To document the published use of local anesthetic injections in sport, according to number of injections, sites of injections, and complications reported.

Data Sources: A systematic search of MEDLINE, Embase, CINAHL, AMED, Cochrane Database of Systematic reviews, SportDiscus, EBSCO Host, and Google Scholar. Read More

J Ultrason 2018 ;18(74):234-239

Oxford University and St Lukes Radiology Oxford Ltd, Oxford, UK.

Diagnosis is crucial in decision-making when treating a patient with shoulder pain. Ultrasound is also very important in the diagnostic and therapeutic pathway, especially when surgery is being considered. This article outlines the diagnostic pathway using the patient's history, physical examination and ultrasound examination. Read More

J Pain Res 2018 11;11:2311-2322. Epub 2018 Oct 11.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

Shoulder pain is a common musculoskeletal disorder of variable etiology, ranging from rotator cuff pathology to peripheral nerve entrapment. Advances in ultrasound (US) technology have allowed static and dynamic evaluation of shoulder problems and most importantly, offer real-time, radiation-free guidance for interventions. The present review aims to describe shoulder anatomy in detail using information from cadaveric models and to illustrate US-guided techniques using clearly labeled figures and videos. Read More

J Ultrasound Med 2019 Mar 31;38(3):605-612. Epub 2018 Aug 31.

Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.

Objectives: Prolotherapy is an injection-based complementary treatment for various musculoskeletal diseases. The aim of this study was to evaluate the therapeutic efficacy of ultrasound-guided prolotherapy in the treatment of acromial enthesopathy and acromioclavicular joint arthropathy.

Methods: Thirty-one patients with chronic moderate-to-severe shoulder pain were recruited from September 2015 to September 2017. Read More

Am J Orthop (Belle Mead NJ) 2018 Jul;47(7)

Midwest Orthopaedics at Rush, Chicago, IL.

Despite advancements in surgical technique and understanding of throwing mechanics, controversy persists regarding the treatment of grade III acromioclavicular (AC) joint separations, particularly in throwing athletes. Twenty-eight major league baseball (MLB) orthopedic team physicians were surveyed to determine their definitive management of a grade III AC separation in the dominant arm of a professional baseball pitcher and their experience treating AC joint separations in starting pitchers and position players. Return-to-play outcomes were also evaluated. Read More

J Am Acad Orthop Surg 2018 May;26(9):303-312

From the Department of Orthopaedic Surgery, University of Pittsburgh Medical Center for Sports Surgery, Pittsburgh, PA.

In the past 30 years, the use of ultrasonography in the field of orthopaedics has evolved. As ultrasonography has been refined, smaller machines with higher fidelity and better transducers have become available at a lower cost. Diagnostic and therapeutic applications of ultrasonography in the shoulder and elbow have expanded imaging options and provided alternatives to surgical management. Read More

Orthop J Sports Med 2018 Feb 22;6(2):2325967118756576. Epub 2018 Feb 22.

Department of Family Community Medicine, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.

Office-based ultrasonography has become increasingly available in many settings, and its use to guide joint and soft tissue injections has increased. Numerous studies have been conducted to evaluate the use of ultrasound-guided injections over traditional landmark-guided injections, with a rapid growth in the literature over the past few years. A comprehensive review of the literature was conducted to demonstrate increased accuracy of ultrasound-guided injections regardless of anatomic location. Read More

Sports Health 2018 Sep/Oct;10(5):453-461. Epub 2018 Feb 22.

Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado.

Background: Previous studies have analyzed the treatment patterns used to manage injuries in National Football League (NFL) players.

Hypothesis: Treatment patterns for injuries in NFL players will have changed over the study period.

Study Design: Descriptive epidemiology study. Read More

Sports Health 2018 May/Jun;10(3):234-243. Epub 2018 Jan 3.

Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado.

Background: Previous studies have analyzed the treatment patterns used to manage injuries in National Collegiate Athletic Association (NCAA) Division I football players.

Hypothesis: Treatment patterns used to manage injuries in NCAA Division I football players will have changed over the study period.

Study Design: Descriptive epidemiology study. Read More

Shoulder Elbow 2018 Jan 9;10(1):4-14. Epub 2017 Apr 9.

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Surgery, Nuffield Orthopaedic Center, University of Oxford, Oxford, UK.

Background: Shoulder pain secondary to acromioclavicular joint pain is a common presentation in primary and secondary care but is often poorly managed as a result of uncertainty about optimal treatment strategies. Osteoarthritis is the commonest cause. Although acromioclavicular pain can be treated non-operatively and operatively, there appears to be no consensus on the best practice pathway of care for these patients, with variations in treatment being common place. Read More

Phys Sportsmed 2018 Feb 13;46(1):98-104. Epub 2017 Dec 13.

f Department of Orthopedics , Harvard Medical School, Beth Israel Deaconess Medical Center , Boston , MA , USA.

Objectives: The clinical examination of the shoulder joint is an undervalued diagnostic tool for evaluating acromioclavicular (AC) joint pathology. Applying evidence-based clinical tests enables providers to make an accurate diagnosis and minimize costly imaging procedures and potential delays in care. The purpose of this study was to create a decision tree analysis enabling simple and accurate diagnosis of AC joint pathology. Read More

J Am Acad Orthop Surg 2017 Dec;25(12):799-807

From the Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD (Dr. McFarland, Dr. Dein, and Dr. Johnson), and the National Sports Medicine Institute, Leesburg, VA (Dr. Bernard).

Injections about the shoulder serve diagnostic as well as therapeutic purposes. Diagnosis of shoulder conditions, such as rotator cuff tears, acromioclavicular joint pathology, subacromial impingement or anterolateral pain syndrome, glenohumeral joint pathology, suprascapular nerve entrapment, and biceps tendon pathologies, is often complicated by concomitant conditions with overlapping symptoms and by inconclusive physical examination and imaging results. Injections of anesthetic agents can often help clinicians locate the source of pain. Read More

Altern Ther Health Med 2018 Jan;24(1):56-60

Context • Shoulder pain is one of the most common pain complaints reported by patients. Consensus is lacking on its ideal treatment, and many different treatments are available and used. Prolotherapy is an injection-based therapy that has shown significant results in treating many common musculoskeletal pain conditions, including osteoarthritis, lateral epicondylosis, and low-back pain. Read More

J Orthop Surg (Hong Kong) 2017 Sep-Dec;25(3):2309499017731633

Trauma and Orthopaedic Department, Royal Blackburn Hospital, Blackburn, UK.

Introduction: Steroid and local anaesthetic injection to the acromioclavicular joint (ACJ) is a very common diagnostic and therapeutic procedure, which is often performed in the outpatient department. However, it can be difficult to localize this joint because of its small size, presence of osteophytes and variable morphology in the population. We performed a study to determine whether the use of an image intensifier (X-ray guidance), in theatre, improves the accuracy of this injection. Read More

Orthopedics 2017 Mar 7;40(2):119-124. Epub 2016 Dec 7.

Distal clavicle osteolysis is an uncommon condition that most commonly affects weight lifters and other athletes who perform repetitive overhead activity. Although this condition most commonly presents in young active men, it is becoming increasing more common in women with the rise in popularity of body building and extreme athletics. Distal clavicle osteolysis can be debilitating, especially in those with rigorous training regimens, preventing exercise because of pain with activities such as bench presses and chest flies. Read More

Acta Orthop Belg 2016 Aug;82(2):161-165

We observed the clinical course, in the short-medium term, of patients with voluminous type II acromio-clavicular (AC) joint cyst who underwent aspiration and steroid injection regarded as the only possible treatment to avoid possible skin complications. Four patients (7.4% of cases described in literature) (3F-1M ; mean age 83 years, range : 78-87 years) with a voluminous ( > 7 cm) oval, no mobile, no fluctuant cyst overlying the AC joint, were retrospectively observed. Read More

Phys Med Rehabil Clin N Am 2016 Aug;27(3):555-72

Department of Orthopaedics and Rehabilitation, Radiology, and Family Medicine, University of Iowa Sports Medicine Center, 2701 Prairie Meadow Drive, Iowa City, IA 52242, USA. Electronic address:

Chronic and acute shoulder pain and dysfunction are common complaints among patients. Shoulder pain may be the result of abnormality involving the rotator cuff, subacromial-subdeltoid bursa, biceps tendon, glenoid labrum, glenohumeral joint, acromioclavicular joint, sternoclavicular joint, or glenohumeral joint capsule. Ultrasound-guided (USG) procedures of the shoulder are well established for interventional management. Read More

Pain Physician 2015 Jul-Aug;18(4):333-41

Department of Rehabilitation Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea; Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Sanggye Paik Hospita.

Background: Primary osteoarthritis (OA) is the most common cause of pain arising from the acromioclavicular (AC) joint. The true incidence is unknown because of differences in the criteria used to define arthritis in various studies. The proper diagnosis of AC joint OA requires a thorough physical examination, radiographic findings, and a diagnostic local anesthetic injection. Read More

Shoulder Elbow 2015 Jul 30;7(3):164-7. Epub 2015 Jan 30.

Department of Orthopaedics, University Hospital Crosshouse, Kilmarnock KA2 0BE, UK.

Background: Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients.

Methods: BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. Read More

Semin Musculoskelet Radiol 2015 Jul 28;19(3):203-11. Epub 2015 May 28.

Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom.

Shoulder ultrasound (US) is one of the most common applications of musculoskeletal US due to the high incidence of rotator cuff disorders. It can be used effectively for the diagnosis of rotator cuff diseases, and several studies have shown very high sensitivity and specificity for rotator cuff tears comparable with that of MRI. Shoulder US has several advantages over MRI such as lower cost, comparatively easier availability, short examination duration, dynamic capability, and ability to perform guided injection at the same appointment. Read More

Pain Pract 2015 Sep 27;15(7):E72-5. Epub 2015 May 27.

Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, U.S.A.

Background: Acromioclavicular joint (ACJ) cysts are uncommon causes of shoulder pain. Type 1 ACJ cysts are limited to the ACJ and form in the presence of intact rotator cuff musculature, while type 2 cysts form secondary to biomechanical instability following rotator cuff tear or rupture.

Case Presentation: A 36-year-old overweight male with history of chronic left grade 2 (Rockwood classification) ACJ separation presented with intermittent pain at the distal superoanterior left clavicle. Read More

Skeletal Radiol 2015 Aug 1;44(8):1135-9. Epub 2015 Apr 1.

School of Health and Medical Sciences, Department of Orthopaedic Surgery, Seton Hall University, 400 South Orange, South Orange, NJ, 07079, USA,

Objective: The purpose of this study was to evaluate the accuracy of in vivo acromioclavicular (AC) joint injections without fluoroscopic guidance and assess whether patient demographics affected the accuracy of injections.

Materials And Methods: A consecutive cohort of patients who presented with painful acromioclavicular joints was prospectively evaluated. All patients had clinical and radiographic evidence of AC arthritis, had failed conservative measures, and thus had received intraarticular corticosteroid injections. Read More

Am J Sports Med 2015 Apr 12;43(4):985-90. Epub 2015 Jan 12.

Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Background: The treatment of symptomatic acromioclavicular joint (ACJ) injury in the rotator cuff (RC) tear has not been well clarified.

Purpose: To compare the clinical results between patients who had distal clavicle resection (DCR) and those who did not during RC repair.

Study Design: Randomized controlled trial; Level of evidence, 1. Read More

Br J Sports Med 2015 Aug 17;49(16):1042-9. Epub 2014 Nov 17.

Division Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Alberta, Canada.

Objective: To compare the accuracy and efficacy of ultrasound (US)-guided injections versus landmark-guided injections of the subacromial space, biceps tendon sheath, acromioclavicular (AC) joint and glenohumeral (GH) joint.

Methods: PubMed, Medline and Cochrane libraries were searched up to 31 July 2013. Two independent authors selected and evaluated randomised controlled trials comparing the accuracy and/or efficacy of US versus landmark-guided injection of the shoulder girdle. Read More

BMJ Case Rep 2014 Nov 9;2014. Epub 2014 Nov 9.

Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden.

Adhesive capsulitis is a painful condition with a prevalence of 2-5%. There is a lack of evidence for its aetiology and for conventional treatment and cost effects. This study describes the treatment effects of manual manipulation of the acromioclavicular joint for adhesive capsulitis in a young woman for persisting pain after mobilisation of the glenohumeral joint under anaesthesia. Read More

Arthroscopy 2015 Feb 11;31(2):205-8. Epub 2014 Oct 11.

Stetson Powell Orthopaedics and Sports Medicine, Burbank, U.S.A.. Electronic address:

Purpose: The aim of this study was to determine the accuracy of anatomic palpation-directed injections in the office setting.

Methods: Two hundred twenty-six shoulders in 208 patients were studied using a 0.2-Tesla extremity scanner after the injection of gadolinium-diethylene triamine pentaacetic acid-saline. Read More

Med Clin North Am 2014 Jul 19;98(4):755-75, xii. Epub 2014 Apr 19.

Department of Orthopaedics and Rehabilitation, Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, 30 Hope Drive, Building A, Hershey, PA 17033, USA. Electronic address:

Shoulder pain is a common reason for a patient to see their primary care physician. This article focuses on the evaluation and management of 3 common shoulder disorders; rotator cuff disorders, acromioclavicular joint arthritis, and glenohumeral joint arthritis. The typical history and physical examination findings for each of these entities are highlighted, in addition to treatment options. Read More

South Med J 2014 May;107(5):324-9

From the Department of Orthopaedic Surgery, Vanderbilt Medical Center, Nashville, Tennessee, the Blue Ridge Bone and Joint Clinic, Mission Sports Medicine, Asheville, North Carolina, Department of Orthopedics and Sports, Harbin Clinic LLC, Rome, Georgia, and the Department of Orthopaedic Surgery and Sports Medicine, Vanderbilt Bone and Joint, Franklin, Tennessee.

Osteoarthritis of the acromioclavicular joint is a frequent cause of shoulder pain and can result in significant debilitation. It is the most common disorder of the acromioclavicular joint and may arise from a number of pathologic processes, including primary (degenerative), posttraumatic, inflammatory, and septic arthritis. Patients often present with nonspecific complaints of pain located in the neck, shoulder, and/or arm, further complicating the clinical picture. Read More

J Med Case Rep 2014 May 7;8:142. Epub 2014 May 7.

Department of Internal Medicine, Easton Hospital, School of Medicine, Drexel University, 250 South 21st Street, Easton, PA 18042, USA.

Introduction: Carcinoid tumors are variants of neuroendocrine tumors that typically arise from the gastrointestinal tract and the bronchus, but they can involve any organ. Unresolved right shoulder pain manifesting as the first clinical presentation of carcinoid tumor with unknown primary origin is a rare clinical entity. To the best of our knowledge, herein we present the first case report describing metastasis to the right shoulder joint in a patient who presented with bone pain as the first clinical manifestation of metastatic carcinoid tumor of unknown primary origin. Read More

J Shoulder Elbow Surg 2014 Oct 13;23(10):e243-50. Epub 2014 Apr 13.

Radiology Department, Poriya Government Hospital, Tiberias, Israel.

Background: Injection into the acromioclavicular (AC) joint is often inaccurate (approximately 50%) even in experienced hands. In light of new anatomic observations, we evaluate accuracy of an innovative ultrasound-guided method and follow the clinical course of successful therapeutic injections.

Method: Relevant anatomy was investigated in 200 three-dimensional computed tomography scans, 100 magnetic resonance images, and 14 cadavers. Read More

Bull Hosp Jt Dis (2013) 2014 ;72(4):266-70

Intra-articular injections have traditionally been performed "blind," guided only by anatomic palpation. Many may be placed inaccurately, and the use of imaging may significantly improve injection accuracy. This review analyzed the impact of ultrasound-guidance on injection accuracy and clinical efficacy in the knee and shoulder joints. Read More

Prim Care 2013 Dec;40(4):889-910, viii

Department of Family Medicine, Mount Sinai Hospital, 1500 South California Avenue, Chicago, IL 60608, USA. Electronic address:

Rotator cuff pathology accounts for most presentations of shoulder pain to primary care clinics. History and physical examination are important for excluding other causes of shoulder pain, while imaging assists in confirming the diagnosis and defining the severity of the abnormality. Treatment options include nonsteroidal anti-inflammatory agents, subacromial corticosteroid injections, and exercise therapy. Read More

Arthroscopy 2013 Dec 18;29(12):1903-10. Epub 2013 Oct 18.

Department for Orthopaedics and Orthopaedic Surgery, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria. Electronic address:

Purpose: The purpose of this randomized study was to compare the clinical efficacy of intra-articular versus periarticular acromioclavicular joint injections.

Methods: In this multicenter, prospective, randomized, controlled trial, 101 patients (106 shoulders) with symptomatic acromioclavicular joints were treated with an injection and were randomly assigned to either the intra-articular group or the periarticular group. To ensure accurate needle placement either intra-articularly or in a periarticular manner, the needle was placed under ultrasound guidance. Read More

Am J Sports Med 2013 Oct;41(10):NP45

Manuel Sabeti, MD.

J Clin Orthop Trauma 2013 Jun 6;4(2):75-9. Epub 2013 Mar 6.

Medical Doctor, Orthopaedic and Trauma Surgery, Ambulatorio di Ortopedia, via della Conciliazione, 65, 74014 Laterza (TA), Italy.

Background: A prospective study was established to assess the sensitivity and specificity of the new Saccomanni (SAC) test for isolated AC pathology, and compare with 4 commonly used clinical tests.

Materials And Methods: The Saccomanni (Sac) test is essentially the cross-adduction test, with the addition of attempted elevation against resistance. In a positive test, this results in some pain and the inability of the patient to maintain the arm in the adducted and elevated position against resistance. Read More

Eklem Hastalik Cerrahisi 2013 ;24(2):77-81

Department of Physical Medicine and Rehabilitation, Medicine Faculty of Afyon Kocatepe University, Afyon, Turkey.

Objectives: This study aims to investigate the effect of acromioclavicular joint (ACJ) degeneration on orthopedic shoulder tests (OST) and to determine complementary role of ACJ injections in the treatment of subacromial shoulder impingements.

Patients And Methods: At a secondary care center, 62 patients (56 females, 6 males; mean age 55.8±9. Read More

Am J Sports Med 2013 Nov 6;41(11):2684-92. Epub 2013 May 6.

Brian J. Cole, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison, Suite 300, Chicago, IL 60612.

Osteoarthritis of the acromioclavicular (AC) joint is a common condition causing anterior or superior shoulder pain, especially with overhead and cross-body activities. This most commonly occurs in middle-aged individuals because of degeneration to the fibrocartilaginous disk that cushions the articulations. Diagnosis relies on history, physical examination, imaging, and diagnostic local anesthetic injection. Read More

BMC Musculoskelet Disord 2013 May 1;14:156. Epub 2013 May 1.

Health and Rehabilitation Research Institute, AUT University, Akoranga Drive, Northcote, Auckland 1142, New Zealand.

Background: Despite numerous methodological flaws in previous study designs and the lack of validation in primary care populations, clinical tests for identifying acromioclavicular joint (ACJ) pain are widely utilised without concern for such issues. The aim of this study was to estimate the diagnostic accuracy of traditional ACJ tests and to compare their accuracy with other clinical examination features for identifying a predominant ACJ pain source in a primary care cohort.

Methods: Consecutive patients with shoulder pain were recruited prospectively from primary health care clinics. Read More

Lakartidningen 2013 Feb 6-12;110(6):286-9

Eur J Orthop Surg Traumatol 2014 Feb 5;24(2):159-64. Epub 2013 Jan 5.

Department of Orthopaedic Surgery, Gildhøj Private Hospital, Copenhagen, Denmark,

Purpose: Painful snapping scapula can be a disabling condition. The object of this prospective study was to assess the efficiency of arthroscopic bone resection of the medial superior corner of scapula, in patients suffering from continuously painful snapping scapula.

Methods: Twenty patients with painful snapping scapula underwent arthroscopic scapulothoracic bursectomi and resection of the hook formation at the medial superior margin of the scapular. Read More

Am J Sports Med 2013 Jan 27;41(1):149-52. Epub 2012 Nov 27.

Winthrop Orthopaedic Associates, Winthrop University Hospital, Garden City, New York, USA.

Background: Injection to the acromioclavicular (AC) joint can be both diagnostic and therapeutic.

Purpose: The purpose of this study was to evaluate the accuracy of in vivo AC joint injections.

Study Design: Case series; Level of evidence, 4. Read More

Ann Rehabil Med 2012 Aug 27;36(4):573-7. Epub 2012 Aug 27.

Department of Rehabilitation Medicine, Inje University, College of Medicine, Ilsan Paik Hospital, Goyang 411-706, Korea.

Candida species inhabit the skin and mucous membranes of healthy individuals with low virulence, and osteomyelitis due to candida is very rare. However, the incidence of invasive candidal infection caused by intravenous drug use, broad-spectrum antibiotics, and indwelling central venous catheter is increasing. A 73-year old man visited the outpatient clinic complaining of right shoulder pain that radiated to the right acromioclavicular joint. Read More

Clin J Pain 2012 Oct;28(8):675-82

AUT University, School of Rehabilitation and Occupation Studies, Christchurch, New Zealand.

Objectives: Key diagnostic decisions often turn on measurement of change in pain intensity after diagnostic anesthetic blocks. This study aimed to introduce a new direct measure pain intensity change and compare it with percent change as calculated from the traditional preprocedure and postprocedure pain visual analog scales.

Methods: Shoulder pain patients enrolled in a diagnostic accuracy study comparing clinical variables with image-guided local anesthetic injections were assessed with both the traditional preprocedure and postprocedure visual analog scales and the new direct method. Read More

Arch Phys Med Rehabil 2012 Jun 5;93(6):949-56. Epub 2012 Apr 5.

Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine and Ajou University Hospital, Suwon, Republic of Korea.

Objective: To evaluate the effect of subacromial corticosteroid injection on hemiplegic shoulder pain (HSP).

Design: Multicenter, randomized, triple-blind, placebo-controlled trial.

Setting: Three primary and 1 university-affiliated tertiary-care hospitals. Read More

J Shoulder Elbow Surg 2012 Dec 3;21(12):1694-7. Epub 2012 Apr 3.

Department of Orthopedics, University of Zurich, Balgrist, Zurich, Switzerland.

Background: Injections of the acromioclavicular joint (ACJ) are performed routinely in patients with ACJ arthritis, both diagnostically and therapeutically. The aim of this prospective controlled study was to estimate the frequency of successful intra-articular ACJ injections with the aid of sonographic guidance versus non-guided ACJ injections.

Materials And Methods: A total of 80 cadaveric ACJs were injected with a solution containing methylene blue and subsequently dissected to distinguish intra- from peri-articular injections. Read More

J Orthop Sports Phys Ther 2012 Feb 25;42(2):66-80. Epub 2011 Oct 25.

Army-Baylor University Doctoral Fellowship in Orthopaedic Manual Physical Therapy, Brooke Army Medical Center, Fort Sam Houston, TX, USA.

Study Design: Prospective single-cohort study.

Objectives: To determine and document changes in pain and disability in patients with primary, nonacute acromioclavicular joint (ACJ) pain treated with a manual therapy approach.

Background: To our knowledge, there are no published studies on the physical therapy management of nonacute ACJ pain. Read More

Reg Anesth Pain Med 2011 Nov-Dec;36(6):592-605

Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Application of ultrasound for musculoskeletal injections is increasingly popular. The common targets for shoulder injection are the subacromial subdeltoid bursa, glenohumeral joint, acromioclavicular joint, and the long head of biceps tendon. This review describes and summarizes the anatomy and sonoanatomy relevant to the injection of these structures. Read More

J Shoulder Elbow Surg 2012 Mar 22;21(3):376-9. Epub 2011 Jun 22.

Department of Orthopaedics and Traumatology, Monica Hospital, Deurne, Antwerp, Belgium.

Background: A prospective study was established to assess the effect of an intra-articular injection of corticosteroid and local anaesthetic into the acromioclavicular (AC) joint.

Methods: Fifty-eight patients with isolated AC joint symptoms were included. Clinical tests were repeated immediately following the injection, as well as at 1-month follow-up. Read More

BMC Musculoskelet Disord 2011 May 28;12:119. Epub 2011 May 28.

Health & Rehabilitation Research Institute, AUT University, Northcote, Auckland, New Zealand.

Background: The prevalence of imaged pathology in primary care has received little attention and the relevance of identified pathology to symptoms remains unclear. This paper reports the prevalence of imaged pathology and the association between pathology and response to diagnostic blocks into the subacromial bursa (SAB), acromioclavicular joint (ACJ) and glenohumeral joint (GHJ).

Methods: Consecutive patients with shoulder pain recruited from primary care underwent standardised x-ray, diagnostic ultrasound scan and diagnostic injections of local anaesthetic into the SAB and ACJ. Read More

PM R 2011 May;3(5):495; author reply 495