Accuracy and Efficacy of Ultrasound-Guided Glenohumeral Joint Injections: A Systematic Review.

Abstract

The aim of the study was to perform a systematic review comparing the accuracy and the efficacy of ultrasound-guided versus landmark-guided and other image-guided glenohumeral joint injections. Embase, PubMed, Scopus, and Web of Science were searched up to June 24, 2023. Independent authors reviewed and selected qualifying randomized controlled studies, cohort studies, and case control/case series comparing either the accuracy and/or clinical efficacy of ultrasound-guided versus landmark-guided and other image-guided glenohumeral joint injections. Two independent authors extracted and synthesized the data. Quality appraisal of the studies was performed using the Cochrane Assessment of Bias tool (RoB2) and Newcastle-Ottawa Quality Assessment Scale, where applicable. A total of nine studies were included in the review, which included eight live human studies and one cadaveric study. Eight studies assessed for accuracy of ultrasound-guided glenohumeral joint injections. Cumulatively, there was a 63%-100% accuracy rate with ultrasound-guided injections compared with 40%-76.19% accuracy rate with blind injections and 72%-100% with fluoroscopic-guided injections. The accuracy rate of ultrasound-guided glenohumeral joint aspirations was 69.4% compared with the accuracy rate of other image-guided modalities, which was 70.6%. Three randomized control studies evaluated the efficacy of ultrasound-guided injections compared with landmark-guided injections by examining pain, range of motion, and function. All three studies did not show a statistically significant difference in the either group in all measures, although one study did show a statistically significant improvement in pain reduction sooner in the ultrasound-guided group. Ultrasound-guided glenohumeral joint injections are more accurate than landmark-guided injections and have similar accuracy rates compared with other imaging modalities. Ultrasound-guided injections are efficacious in treating glenohumeral joint disorders but not superior to landmark-guided injections. Future research should focus on standardized protocols, larger sample sizes, and long-term follow-up to obtain more robust evidence to determine the superiority of ultrasound-guided injections.