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Int J Surg Case Rep 2022 Jun 19;95:107214. Epub 2022 May 19.

OIH (Oman International Hospital), Muscat, Oman. Electronic address:

Introduction: Rotator cuff constitutes a mechanical arm and an important stabilizing factor for the shoulder joint, and the supraspinatus muscle is the initiator of the movement of arm in the abduction direction. Rotator cuff injuries constitute an important part of the shoulder pain, and many cases are managed conservatively, nevertheless, open or arthroscopic surgery remains a must in many cases.

Case Report: We present the case of a patient in the sixth decade of life who complained of absence of abduction movement in his right shoulder three months ago after he lifted a heavy object. Read More

Musculoskeletal Care 2022 May 5. Epub 2022 May 5.

Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.

Introduction: Rotator cuff related shoulder pain (RCRSP) is the most common presentation of shoulder pain within physiotherapy. Corticosteroid injections (CSI) have become increasingly popular to reduce pain, increase range of motion (ROM) and improve shoulder function. Evidence around the use of ultrasound-guided (USG) versus landmark-guided (LMG) CSIs remains controversial. Read More

Ned Tijdschr Geneeskd 2022 04 12;166. Epub 2022 Apr 12.

LUMC, afd. Orthopedie, Leiden.

Frozen shoulder (FS), also known as adhesive capsulitis, is a painful inflammatory fibrotic disease of the glenohumeral joint capsule. While it's frequently self-limiting, patients can be symptomatic for years. The clinical course is often divided into three phases: the freezing phase with predominantly pain, the frozen phase with mainly stiffness, and the thawing phase during which the complaints slowly resolve. Read More

Arthroscopy 2022 04;38(4):1035-1036

Steadman Clinic and Steadman Philippon Research Institute, Vail, Colorado, U.S.A.

Glenohumeral arthritis is a challenging problem, especially in the young, active patient. After nonoperative treatment, including activity modification, anti-inflammatory medications, physical therapy, and injections, is exhausted, surgical treatment ranging from simple debridement to arthroplasty is commonly offered. Given concerns regarding arthroplasty implant longevity, there is an interest in joint-preserving procedures. Read More

Clin Orthop Relat Res 2022 Jul 24;480(7):1241-1250. Epub 2022 Mar 24.

Department of Orthopaedic Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Background: Shoulder injury related to vaccine administration (SIRVA) is postulated to be an immune-mediated inflammatory response to a vaccine antigen injected into or near the subacromial bursae or synovium, leading to shoulder pain and dysfunction. The number of studies on this topic is rapidly increasing. Recent comparative studies have reported conflicting conclusions, which suggests that a systematic review of the best-available evidence may be helpful. Read More

Musculoskeletal Care 2022 Mar 22. Epub 2022 Mar 22.

Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK.

Objectives: To investigate whether the accuracy of placement of ultrasound-guided (US-guided) corticosteroid injections for subacromial pain (impingement) syndrome (SAPS) influences pain and function outcomes.

Methods: This was a secondary analysis of data collected in a previous randomised controlled trial (RCT). Video images of US-guided subacromial corticosteroid injections delivered in the RCT were reviewed to categorise injection accuracy into three groups: definitely/probably not in the subacromial bursa (Group 1); probably in the subacromial bursa (Group 2); and definitely in the subacromial bursa (Group 3). Read More

J Shoulder Elbow Surg 2022 Jun 12;31(6S):S131-S135. Epub 2022 Mar 12.

Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA. Electronic address:

Background: Treating high-grade (grade 2 and 3) partial-thickness rotator cuff tears after failed conservative care remains challenging. Arthroscopic repair techniques are often considered with or without subacromial decompression and biological injections. More recently, a bioinductive bovine collagen patch (Regeneten; Smith & Nephew, Memphis, TN, USA) has been proposed to create a healing response and thicken the injured tendon. Read More

J Clin Med 2022 Feb 16;11(4). Epub 2022 Feb 16.

Department of Orthopaedic Surgery, Kangdong Sacred Heart Hospital, Seoul 05355, Korea.

We investigated the complications and frequency of hook plate fixation in patients with shoulder trauma. We reviewed 216 cases of hook plate fixation use at our hospital between January 2010 and May 2020. Finally, we included 76 cases of acute distal clavicle fracture (DCF) and 84 cases of acute acromioclavicular joint dislocation (ACD). Read More

Clin Shoulder Elb 2022 Mar 25;25(1):28-35. Epub 2022 Jan 25.

Department of General and Plastic Surgery, Turku University Hospital, University of Turku, Turku, Finland.

Background: Given the complications involved in corticosteroid (CS) injections, subacromial platelet-rich plasma (PRP) injections may provide a valid alternative to CS in the treatment of rotator cuff (RC) tendinopathy.

Methods: We retrospectively reviewed a total of 98 patients affected by RC tendinopathy who were treated with either subacromial injection of PRP or CS. The PRP group received three injections of autologous PRP at 2 weeks interval, and the CS group received one injection of CS. Read More

Am J Phys Med Rehabil 2021 Dec 23. Epub 2021 Dec 23.

Department of School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China, 610072. Rehabilitation Medicine Center, Sichuan Key Laboratory of Rehabilitation Medicine, Institute for Physical Medicine and Rehabilitation, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China, 610041. Department of Eastern Hospital, Sichuan Academy of Medical Sciences. & Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, People's Republic of China, 610100 Department of Affiliated Sichuan Provincial Rehabilitation Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan Bayi Rehabilitation Center, Chengdu, Sichuan Province, People's Republic of China, 611130. Chongqing medical university, Yuzhong District, Chongqing, People's Republic of China, 400016.

Objective: To compare the efficacy and safety of ultrasound-guided (USG) versus anatomic landmark-guided (ALG) corticosteroid injection for the treatment of subacromial impingement syndrome (SIS).

Design: PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Scopus, ClinicalTrials.gov, CBM, CNKI and Wanfang databases were searched from inception to August 15, 2021, for randomized controlled trials (RCTs) comparing USG versus ALG injections of corticosteroids for the treatment of SIS. Read More

Semin Musculoskelet Radiol 2021 Dec 22;25(6):769-784. Epub 2021 Dec 22.

Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

Musculoskeletal injections serve a variety of diagnostic and therapeutic purposes, with ultrasonography (US) guidance having many advantages: no ionizing radiation, real-time guidance, high spatial resolution, excellent soft tissue contrast, and the ability to identify and avoid critical structures. Sonography can be cost effective and afford flexibility in resource-constrained settings. This article describes US-guided musculoskeletal injections relevant to many radiology practices and provides experience-based suggestions. Read More

Arthroscopy 2022 05 15;38(5):1642-1657. Epub 2021 Dec 15.

Department of Joint Surgery and Sports Medicine, Wang Jing Hospital, China Academy of Chinese Medical Sciences, Beijing. Electronic address:

Purpose: To perform a meta-analysis comparing the clinical and functional outcomes of ultrasound-guided (USG) and blind injections for shoulder pain.

Method: The Embase, Cochrane Library, and PubMed databases were searched from database inception to April 7, 2021. Clinical and functional outcomes included the visual analog scale (VAS) pain score, abduction, flexion, American Shoulder and Elbow Surgeons Assessment Form (ASES) score, Constant-Murley Shoulder (CMS) score, Shoulder Pain and Disability Index (SPADI), Shoulder Disability Questionnaire (SDQ) score, and Shorted Disabilities of the Arm, Shoulder and Hand (Quick DASH) score. Read More

Heliyon 2021 Nov 23;7(11):e08442. Epub 2021 Nov 23.

Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA.

Background: Chronic shoulder pain occurs rarely after a vaccination and is hypothesized to arise from the effects of unintentional vaccine injection into the subacromial bursa, rotator cuff, capsule or underlying bone. The avascular nature of the rotator cuff, as well as unknown genetic and environmental factors, may predispose to the persistence of pain and disability, referred to as vaccination-related shoulder dysfunction and shoulder injury related to vaccine administration (SIRVA).

Methods: Ultrasonography, sonopalpation and ultrasound-guided anesthetic injections were used to locate the anatomical source of chronic (mean 20, range 8-42 months) shoulder pain after a vaccination in a consecutive series of 5 patients. Read More

Curr Med Imaging 2021 Dec 5. Epub 2021 Dec 5.

Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy.

Shoulder pain is an extremely common condition. The painful shoulder may be the result of a wide spectrum of underlying pathological conditions, including calcific tendinopathy of the rotator cuff, subacromial-subdeltoid bursitis, acromioclavicular or glenohumeral arthritis, tenosynovitis of the long biceps tendon, rotator cuff lesions, and many other less common conditions. Ultrasound imaging is an effective tool for the diagnosis and also for the image guidance of treatment of the majority of these conditions. Read More

Clin J Sport Med 2021 Nov 10. Epub 2021 Nov 10.

Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Clinical Biomechanics and Ergonomics Research Center, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran; and Department of Food Hygiene and Technology, University of Leon, Leon, Spain.

Objective: Shoulder tendinopathy is a prevalent and debilitating problem. We compared the effects of subacromial high- or low-molecular-weight hyaluronate injection with physical therapy (PT) in shoulder tendinopathy.

Design: A triple-blinded randomized controlled trial. Read More

Ann Anat 2022 Jan 16;239:151814. Epub 2021 Sep 16.

MoMaRC Morphological Madrid Research Center, Calle Arzobispo Morcillo, 4, 28029 Madrid, Spain; Department of Anesthesia and Chronic Pain, Móstoles University Hospital, C. Gladiolo, s/n, 28933 Móstoles, Spain. Electronic address:

Shoulder pain is a highly prevalent condition, often resulting in major life limitations, and requiring effective treatments. In this work, we explore the anatomical basis of a proposed approach to the regional anesthesia of the shoulder through a single injection under the subscapularis muscle. Bilateral experimental injections in shoulders from body donors (Radiolar ® and Methylene-Blue) under the subscapular muscle (n = 11) and cadaveric systematic dissections of other 35 shoulders from body donors were performed. Read More

Ther Adv Musculoskelet Dis 2021 9;13:1759720X211037530. Epub 2021 Sep 9.

Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK.

Background: There are currently many treatment options for patients with subacromial shoulder conditions (SSCs). Clinical decision-making regarding the best treatment option is often difficult. This study aims to evaluate the comparative effectiveness of treatment options for relieving pain and improving function in patients with SSCs. Read More

Clin Shoulder Elb 2021 Sep 18;24(3):166-171. Epub 2021 Aug 18.

Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

Background: This study aims to compare the clinical outcomes of steroid injections during the rehabilitation period after arthroscopic rotator cuff repair (ACRC).

Methods: Among patients who underwent ARCR, 117 patients who met the inclusion and exclusion criteria were enrolled. Pain and range of motion (ROM) recovery at the 3-, 6-, and 24-month follow-up visits and functional outcome at the 24-month follow-up were compared between 45 patients who received ultrasound-guided subacromial steroid injection at postoperative week 4 or 6 and 72 patients who did not. Read More

Arthroscopy 2021 09;37(9):2754-2755

West Palm Beach, Florida.

Platelet-rich plasma (PRP) injections continue to be used at increasing rates to treat common musculoskeletal conditions. PRP has a low-risk profile and emerging in vitro evidence to support its positive effects on soft-tissue healing. PRP has been shown to be of benefit for knee osteoarthritis, but less has been published regarding the shoulder. Read More

Malays Orthop J 2021 Jul;15(2):55-61

Department of Orthopaedics, Mahatma Gandhi Medical College and Research Institute Sri Balaji Vidyapeeth University, Pondicherry, India.

Introduction: Rotator cuff tendinitis has been treated using various methods including physiotherapy, steroid injections and recently platelet rich plasma (PRP). Most of these methods aim at giving symptomatic relief rather than addressing the pathology. There is no clear consensus over the benefit of using PRP for tendinitis. Read More

Health Technol Assess 2021 08;25(48):1-158

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.

Background: Rotator cuff-related shoulder pain is very common, but there is uncertainty regarding which modes of exercise delivery are optimal and the long-term benefits of corticosteroid injections.

Objectives: To assess the clinical effectiveness and cost-effectiveness of progressive exercise compared with best-practice physiotherapy advice, with or without corticosteroid injection, in adults with a rotator cuff disorder.

Design: This was a pragmatic multicentre superiority randomised controlled trial (with a 2 × 2 factorial design). Read More

Lancet 2021 07 12;398(10298):416-428. Epub 2021 Jul 12.

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; College of Medicine and Health, University of Exeter, Exeter, UK.

Background: Corticosteroid injections and physiotherapy exercise programmes are commonly used to treat rotator cuff disorders but the treatments' effectiveness is uncertain. We aimed to compare the clinical effectiveness and cost-effectiveness of a progressive exercise programme with a single session of best practice physiotherapy advice, with or without corticosteroid injection, in adults with a rotator cuff disorder.

Methods: In this pragmatic, multicentre, superiority, randomised controlled trial (2 × 2 factorial), we recruited patients from 20 UK National Health Service trusts. Read More

J Ultrason 2021 Jun 18;21(85):e162-e168. Epub 2021 Jun 18.

IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.

Ultrasound is a fast, accessible, reliable, and radiation-free imaging modality routinely used to assess the soft tissues around the shoulder. It enables to identify a wide range of pathological conditions. Furthermore, most ultrasound-guided musculoskeletal interventional procedures around the shoulder produce better results in terms of accuracy and clinical efficacy than those performed in a blinded fashion. Read More

Adv Biomed Res 2021 30;10:12. Epub 2021 Mar 30.

Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Shoulder pain is the third most common type of musculoskeletal disorder and rotator cuff (RC) tendinopathy is the most frequent diagnosis. Ultrasound is the most preferable guidance tool for diagnostic and interventional purposes. The aim of this study is to compare the effectiveness of the prolotherapy injection with corticosteroid injection in patients with RC dysfunction. Read More

J Orthop Surg Res 2021 May 21;16(1):333. Epub 2021 May 21.

Department of Orthopedic Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

Background: Studies evaluating the role of both corticosteroids and platelet-rich plasma (PRP) in the treatment of rotator cuff (RC) tendinopathies have been contradicting. We compared structural and clinical changes in RC muscles after corticosteroids and PRP injections.

Methods: This is a randomized double-blind clinical trial. Read More

Clin Orthop Relat Res 2021 11;479(11):2483-2489

Alrijne Hospital, Leiden, the Netherlands.

Background: Shoulder injections for conditions such as adhesive capsulitis are commonly performed and can be administered through image-based or landmark-based injection approaches. Ultrasound-guided injections are widely used and accurate because ultrasound allows real-time visualization of the needle and injected contrast. Landmark-based injections would be advantageous, if they were accurate, because they would save the time and expense associated with ultrasound. Read More

Arthroscopy 2021 09 20;37(9):2745-2753. Epub 2021 Apr 20.

Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Purpose: The purpose of this study was to evaluate the effect of subacromial platelet-rich plasma (PRP) injections in patients with refractory rotator cuff tendinopathies based on pain improvement, functional outcomes, sleep disturbances, and return to sports to the same level as before the injury.

Methods: Between March 2019 and October 2019, 50 patients with rotator cuff tendinopathy refractory to conservative treatment were treated with one subacromial PRP injection in our institution. Magnetic resonance imaging was performed in all patients to confirm diagnosis. Read More

Clin Rehabil 2021 Sep 15;35(9):1305-1316. Epub 2021 Apr 15.

Department of Physical Medicine & Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei.

Objective: To analyse the effectiveness of corticosteroid (CS) and hyaluronic acid (HA) subacromial - subdeltoid (SASD) injection compared with normal saline (NS) in patients with chronic subacromial bursitis (CSB).

Design: A prospective three-arm double-blinded randomised controlled trial.

Setting: Rehabilitation department of two teaching hospitals. Read More

J Spinal Cord Med 2021 11 8;44(6):886-895. Epub 2021 Apr 8.

Kessler Foundation, West Orange, New Jersey, USA.

Context/objectives: Wheelchair users with chronic shoulder pain have few options after conservative treatments fail. This pilot study's purpose was to establish safety and treatment effects of micro-fragmented adipose tissue (MFAT) injections under ultrasound guidance for treatment of refractory shoulder pain caused by rotator cuff disease in wheelchair users with spinal cord injury (SCI) to prepare for a larger trial.

Design: Pilot clinical trial. Read More

Am J Sports Med 2021 03;49(4):883-891

Department of Rheumatology, CHU Nantes, Nantes, France.

Background: Calcific tendinitis of the rotator cuff is a frequent cause of shoulder pain. Ultrasound-guided percutaneous lavage (UGPL) is an effective treatment, but factors associated with good clinical and radiological outcomes still need to be identified.

Purpose: To study the clinical, procedural, and radiological characteristics associated with improved shoulder function and the disappearance of calcification on radiograph after UGPL. Read More