A comparison of the effectiveness of landmark-guided injections and ultrasonography guided injections for shoulder pain

Clin J Pain. Nov-Dec 2009;25(9):786-9. doi: 10.1097/AJP.0b013e3181acb0e4.


Aim: To compare the effectiveness of landmark-guided local injections and ultrasonography (USG) guided injections for shoulder pain.

Methods: A total 60 consecutive patients with shoulder pain due to soft tissue disorders was enrolled, and randomly assigned to receive triamcinolone (40 mg) either by landmark-guided (LMG, n=30) or USG guided (n=30) injection. The patients were evaluated on admission and 6 weeks after the injection. Clinical assessment included demographic and clinical data, a visual analoge scale (VAS) for pain (0 to 10 cm), the Constant scale (0 to 100) for function, passive and active shoulder range of motion (ROM) with goniometric evaluation, and postinjection adverse effects.

Results: Initial demographic, clinical and USG findings in the groups exhibited no significant differences. Six weeks after injection, the VAS and the Constant score showed a significantly better improvement in USG group compared with LMG group (mean VAS score decrease: 4.0+/-1.7 for USG vs. 2.2+/-0.9 for LMG, P<0.05; mean Constant score change: 32.2 for USG vs. 12.2 for LMG, P<0.05). Significant improvements were observed in active and passive ROM values in both groups, USG group values being better. Initially 18 patients in LMG and 24 patients in USG had limited shoulder ROM, of which 6 was returned to normal values in LMG group and 12 in USG group at 6 week after injection (P<0.05).

Conclusions: Our results indicate that the injection of corticosteroids to patients with shoulder pain due to soft tissue disorders under the USG-guidance may improve therapeutic effectiveness and reduce adverse effects.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anti-Inflammatory Agents / pharmacology
  • Anti-Inflammatory Agents / therapeutic use*
  • Female
  • Humans
  • Injections, Intra-Articular / methods*
  • Male
  • Middle Aged
  • Pain Measurement / methods
  • Prospective Studies
  • Range of Motion, Articular / drug effects
  • Shoulder Pain* / diagnostic imaging
  • Shoulder Pain* / drug therapy
  • Shoulder Pain* / physiopathology
  • Statistics, Nonparametric
  • Triamcinolone / pharmacology
  • Triamcinolone / therapeutic use*
  • Ultrasonography / methods*


  • Anti-Inflammatory Agents
  • Triamcinolone