A prospective study of 100 patients with rotator cuff tendinopathy: no correlation between subacromial bursitis and efficacy of ultrasound-guided corticosteroid injection

The verdict

If a shoulder ultrasound or MRI shows bursitis, does that mean a steroid injection is more likely to relieve my rotator cuff pain?

In this study, the amount of subacromial bursitis seen on imaging did not predict whether an ultrasound-guided steroid injection relieved rotator cuff tendinopathy. Bursitis on a scan should not be used to decide who gets an injection.

ChallengesRead paper

Cohort study100 ParticipantsModerate evidence

Key points

Researchers tracked 100 patients with rotator cuff tendinopathy who received an ultrasound-guided subacromial steroid injection.
They compared how much bursal inflammation each patient had on ultrasound or MRI against how well the injection worked.
There was no significant link between bursitis severity and injection success.
Whether the injection helps cannot be predicted from bursal imaging alone.
The authors conclude bursitis on a scan should not be used to select patients for injection.

How it was conducted

Design: Prospective cohort study
Participants: 100 patients with rotator cuff tendinopathy
Imaging: Subacromial bursal inflammation assessed on ultrasound or MRI
Intervention: Ultrasound-guided subacromial corticosteroid injection
Comparison: Bursitis severity versus injection efficacy

What they found

No significant correlation between subacromial bursitis severity and the efficacy of the injection.
Clinical response to injection was not predictable from bursal imaging alone.

Limitations

This summary is based on a brief structured abstract, so exact effect sizes, confidence intervals, and p-values are not reported here.
A single-cohort observational design without a comparison group limits how firmly cause and effect can be established.
Outcome and response measures are not described in detail, so the definition of injection efficacy is unclear.
Results come from one patient group at one setting and may not generalize to all shoulder pain patients.

Why it matters

For patients: Seeing bursitis on your shoulder scan does not by itself tell you whether a steroid injection will ease your pain.
For clinicians: Bursal inflammation on ultrasound or MRI should not be used as the criterion for selecting rotator cuff tendinopathy patients for subacromial corticosteroid injection.
For readers: Imaging findings of bursitis did not correlate with how well injections worked, so the scan is not a reliable predictor of injection benefit.

Source

doi:10.1007/s00330-023-09989-z

Read the original paper

Clinically assessing this area? See the shoulder special tests.