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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.
Pain Physician
|August 4, 2026
Summary
Ultrasound-guided (USG) corticosteroid injections show superior pain relief for the brachial bicipital groove compared to landmark-guided (LMG) injections. For other shoulder areas, both USG and LMG approaches offer similar efficacy.
Area of Science:
- Orthopedics
- Musculoskeletal Medicine
- Pain Management
Background:
- Shoulder pain is commonly treated with corticosteroid injections.
- Ultrasound-guided (USG) and landmark-guided (LMG) injections are prevalent methods.
- Conflicting evidence exists regarding the comparative efficacy of USG versus LMG injections.
Purpose of the Study:
- To resolve discrepancies in existing meta-analyses comparing USG and LMG injections for shoulder pain.
- To identify the highest-quality evidence on injection efficacy.
- To provide clear clinical recommendations for shoulder pain management.
Main Methods:
- A cross-sectional analysis of existing systematic reviews and meta-analyses.
- Literature search in PubMed, Embase, and Cochrane Library up to February 2025.
- Assessment of methodological quality using AMSTAR scores and the Jadad decision algorithm.
Main Results:
- Nine meta-analyses were analyzed, with AMSTAR scores ranging from 5 to 9.
- One high-quality study identified via the Jadad algorithm.
- USG injections showed no significant advantage over LMG for subacromial bursa and glenohumeral joint targets.
- USG injections were more effective for brachial bicipital groove targeting.
Conclusions:
- USG injections are recommended for brachial bicipital groove targeting due to superior pain reduction.
- LMG injections remain suitable for subacromial bursa or glenohumeral joint injections.
- Limitations include potential language bias and reliance on Level II evidence.
