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Ultrasound- Versus Landmark-Guided Corticosteroid Injections for Shoulder Pain: Evaluating the Overlapping
Ying Du1, Bowen Shi2, Zhendong Xu3
1Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Background:
Shoulder pain is frequently treated with corticosteroid injections administered via ultrasound-guided (USG) or landmark-guided (LMG) approaches. Despite the widespread use of these injections, consensus on their comparative efficacy is lacking due to conflicting results reported in prior meta-analyses.
Objective:
To compare overlapping meta-analyses of USG to those of LMG injections in order to resolve current discrepancies, determine the highest-quality evidence, and offer clear recommendations for clinical practice.
Study Design:
A cross-sectional analysis.
Setting:
English-language systematic reviews and meta-analyses searched in PubMed, Embase, and Cochrane Library up to February 12, 2025, regarding USG management of shoulder pain.
Methods:
A comprehensive literature search was conducted to identify meta-analyses of randomized controlled trials (RCTs) that assessed USG and LMG corticosteroid injections in the treatment of shoulder pain. Methodological quality of the included meta-analyses was assessed, and the Assessment of Multiple Systematic Reviews (AMSTAR) scores were calculated. The Jadad decision algorithm was applied to determine the highest-quality evidence.
Results:
The analysis encompassed 9 meta-analyses, the AMSTAR ratings of which ranged between 5 and 9. Through the Jadad algorithm, one high-quality study was identified. Its findings indicated that USG injections did not significantly outperform LMG injections in terms of pain relief or functional outcomes for subacromial bursa and glenohumeral joint targets. However, for injections involving the brachial bicipital groove, the USG approach demonstrated greater efficacy in alleviating pain.
Limitations:
First, the restriction to English-language literature might have introduced language bias by excluding relevant non-Anglophone studies. Second, the included studies provided only Level II evidence, so this analysis could not establish clinical recommendations grounded in the highest tier (Level I) of empirical support.
Conclusions:
USG corticosteroid injections are recommended for targeting the brachial bicipital groove due to their superior efficacy in pain reduction, while LMG injections remain appropriate for the subacromial bursa or glenohumeral joint.
