Fortunato Sorrentino MD, Presenter: Nothing to Disclose

Angelo Iovane MD, Abstract Co-Author: Nothing to Disclose

Antonio Nicosia MD, Abstract Co-Author: Nothing to Disclose

Angelo Vetro MD, Abstract Co-Author: Nothing to Disclose

Fabrizio Mantia MD, Abstract Co-Author: Nothing to Disclose

Roberto Lagalla MD, Abstract Co-Author: Nothing to Disclose

The aim of the study was to evaluate the outcomes of ultrasound (US)-guided viscosupplementation and intra-articular steroid injection in shoulder impingement syndrome (SIS) and arthrosynovitis (AS) in patients not elegible for surgery.

Over a period of 20 months, we submitted to US-guided viscosupplementation and intra-articular steroid injection 18 patients (12 men; mean age, 70± 4,5 years) with symptomatic SIS and AS (13 right-sided) not elegible for surgery. Inclusion criteria were symptomatic SIS with complete full-thickness tear of supraspinatus tendon with large tendon retraction in tendinopathy, AS and not elegibility for surgery. Clinical assessment included clinical history and examination; a 10 cm Visual Analogue Scale (VAS) score for pain and abduction/adduction range of movement (ROM), using neutral zero method, were assessed. Three intra-articular US-guided shoulder injection of hyaluronic acid (1 per week for 3 consecutive weeks; 1st and 3rd injections with low molucular weight (m-w)hyaluronic acid (HA) and 2nd with high m-w HA) were performed using a 7.5 MHz linear-array transducer with a 20-gauge spinal needle free-hand inserted with an antero-inferior approach. Before the 1st viscosupplementation an intra-articular steroid injection was performed. Kinesiotherapy 3 times/week for 4 weeks was associated. Clinical improvement was assessed comparing VAS score and ROM before (T0) and after treatments at 4 weeks (T1), 3 (T2) and 6 (T3) months.

Mean VAS score and ROM value at T0 were 8.3± 0.5 and 63± 27°, respectively. The viscosupplementation and intra-articular steroid injection allowed to obtain a clinical improvement in 83.3% of cases at T1, with a reduction of VAS score to 3± 0.5 and an improvement of ROM to 164± 7° at T1, with persistence of improvement in 50% at T2 and 38.9% of cases at T3.

US-guided viscosupplementation with 3 alternate injections (2 low molecular weight and 1 high molecular weight) of hyaluronic acid and intra-articular injection of steroid are useful tools in treatment of patients with symptomatic SIS and AS, with a significant improvement of clinical status at follow-up in a little less than half part of people.

SIS with AS is a painful and disabling condition not always elegible for surgery but sometimes useful treated with US-guided viscosupplementation and intraarticular steroid injection.

Sorrentino, F, Iovane, A, Nicosia, A, Vetro, A, Mantia, F, Lagalla, R, Ultrasound-guided Viscosupplementation and Intra-articular Steroid Injection in Shoulder Impingement Syndrome and Arthrosynovitis in Patients Not Eligible for Surgery.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6022354.html