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European Radiology

, Volume 29, Issue 12, pp 6416–6424 | Cite as

Value of MR arthrography findings for pain relief after glenohumeral corticosteroid injections in the short term

  • Benjamin FritzEmail author
  • Filippo Del Grande
  • Reto Sutter
  • Silvan Beeler
  • Cynthia K. Peterson
  • Christian W. A. Pfirrmann
Musculoskeletal

Abstract

Objectives

This study was conducted in order to determine the predictive value of MR arthrography findings for pain relief after glenohumeral corticosteroid injection.

Methods

This study prospectively enrolled 212 patients (mean age 51.4 years; range 15–90) who underwent fluoroscopy-guided glenohumeral corticosteroid injection. All patients received MR arthrography of the shoulder less than 3 months prior to the infiltration and returned questionnaires which assessed patients’ shoulder pain using the 11-point numeric rating scale (NRS), covering a 1-month follow-up period. MR arthrograms were retrospectively assessed for abnormalities of the rotator cuff, long biceps tendon, glenohumeral bone, cartilage, and labrum as well as for synovitis, bursitis, and signs of adhesive capsulitis. MR arthrography findings were compared to patients’ NRS change using the Mann–Whitney U and Kruskal–Wallis tests for univariate analysis and multiple linear regression for multivariate analysis.

Results

Pain reduction of ≥ 2 points was considered to represent clinically relevant improvement, which was seen in 71% of patients 1 week and in 74% of patients 1 month after glenohumeral injection. Univariate analysis of MR findings showed that signs of adhesive capsulitis and an intact labrum were associated with significantly higher NRS reductions after 1 month in comparison to patients without these findings (median 4 vs. 3, p = 0.007 and 4 vs. 2, p = 0.003, respectively). Multivariate analysis proved both factors to be independent predictors of improved outcome after 1 month (beta = 0.176, p = 0.039 and beta = 0.212, p = 0.001, respectively).

Conclusions

Glenohumeral corticosteroid injections for pain relief have a high success rate with 74% of patients reporting clinically relevant improvement after 1 month. Signs of adhesive capsulitis and an intact labrum on MR arthrography are independent predictors of a better outcome.

Key Points

• Seventy-four percent of patients report clinically relevant improvement 1 month after glenohumeral corticosteroid injection.

• Signs of adhesive capsulitis and an intact labrum on MR arthrography are independent predictors of a high pain level decrease.

Keywords

Magnetic resonance imaging Shoulder joint Intra-articular injections Adhesive capsulitis Glenoid labrum 

Abbreviations

IQR

Interquartile range

MR

Magnetic resonance imaging

NRS

Numeric rating scale

SD

Standard deviation

SLAP

Superior labrum anterior and posterior

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Christian Pfirrmann.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

A subsample of the patients included into this study was already included in a former study of Dietrich et al in 2014 ( https://doi.org/10.1007/s00330-014-3403-7) comparing the outcomes after subacromial and glenohumeral corticosteroid injections based on the degree of lateral extension of the acromion, assessed on radiographs. However, no associations with shoulder disorders assessed on MRI have been assessed; therefore, the overlap with the current study is minor.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.RadiologyBalgrist University HospitalZurichSwitzerland
  2. 2.Faculty of MedicineUniversity of ZurichZurichSwitzerland
  3. 3.Department of RadiologyOspedale Regionale di LuganoLuganoSwitzerland
  4. 4.Department of Orthopaedic SurgeryBalgrist University HospitalZurichSwitzerland

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