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Accuracy and Efficacy of Ultrasound-Guided Glenohumeral Joint Injections: A Systematic Review
Renee Enriquez1, Eric Jones1, Levent Özçakar2
1From the Department of Physical Medicine and Rehabilitation, The University of Texas Southwestern, Dallas, Texas.
Objective:
The aim of the study was to perform a systematic review comparing the accuracy and the efficacy of ultrasound-guided versus landmark-guided and other image-guided glenohumeral joint injections.
Methods:
Embase, PubMed, Scopus, and Web of Science were searched up to June 24, 2023. Independent authors reviewed and selected qualifying randomized controlled studies, cohort studies, and case control/case series comparing either the accuracy and/or clinical efficacy of ultrasound-guided versus landmark-guided and other image-guided glenohumeral joint injections. Two independent authors extracted and synthesized the data. Quality appraisal of the studies was performed using the Cochrane Assessment of Bias tool (RoB2) and Newcastle-Ottawa Quality Assessment Scale, where applicable.
Results:
A total of nine studies were included in the review, which included eight live human studies and one cadaveric study. Eight studies assessed for accuracy of ultrasound-guided glenohumeral joint injections. Cumulatively, there was a 63%-100% accuracy rate with ultrasound-guided injections compared with 40%-76.19% accuracy rate with blind injections and 72%-100% with fluoroscopic-guided injections. The accuracy rate of ultrasound-guided glenohumeral joint aspirations was 69.4% compared with the accuracy rate of other image-guided modalities, which was 70.6%. Three randomized control studies evaluated the efficacy of ultrasound-guided injections compared with landmark-guided injections by examining pain, range of motion, and function. All three studies did not show a statistically significant difference in the either group in all measures, although one study did show a statistically significant improvement in pain reduction sooner in the ultrasound-guided group.
Conclusions:
Ultrasound-guided glenohumeral joint injections are more accurate than landmark-guided injections and have similar accuracy rates compared with other imaging modalities. Ultrasound-guided injections are efficacious in treating glenohumeral joint disorders but not superior to landmark-guided injections. Future research should focus on standardized protocols, larger sample sizes, and long-term follow-up to obtain more robust evidence to determine the superiority of ultrasound-guided injections.
