Subacromial Corticosteroid Injection: Efficacy and Accuracy of the Three Main Approaches
The aim of this study was to review the literature available regarding the various sites and techniques for corticosteroid injection of the subacromial space of the shoulder. Efficacy of corticosteroid injection in this area and accuracy of injection in three different sites were used as determinants. Data was collected using PubMed, ScienceDirect, JStorOnline, MedLine, WebScience, AccessMedicine, eMedicine, DynaMed, and Natural Medicine databases. Articles regarding injection site, technique, efficacy of subacromial corticosteroid injection, and measurement of injection accuracy were reviewed, as were articles clearly defining a preference for one site or method of injection over another. Twenty articles were reviewed and the three major techniques of subacromial injection are the anterolateral approach, the lateral approach, and the posterolateral approach. The exact point of injection may differ slightly based on physician preference, however the methods used to identify key anatomical landmarks for each injection site remain similar throughout the literature. Corticosteroid injection of all three sites either reduced patient pain levels, increased range of motion, or both. Up to 91% of test subjects have experienced improvement in one or both of these areas following corticosteroid injection (Yu et al 2006). Though there was no consensus over which approach is the most accurate, the evidence suggested that physician confidence of accurate injection and actual measured accuracy differ by as much as 20% (Blair et al. 1996). There was no preference, as defined by the literature, between general practitioners and surgeons in regard to site or technique.