Paolo Simoni1,2, Marco Grumolato3, Olivier Malaise4, Marco Preziosi5, Francoise Pasleau6, Fréderic de Lemos Esteves6. 1. Radiology Department, "Reine Fabiola" Children's University Hospital, 15, Avenue Jean Joseph Crocq, 1020, Brussels, Belgium. paoloemiliosimoni@gmail.com. 2. Rheumathology Department, Univesity of Liège, Avenue de l'Hopital 11-Bât B34, 4000, Liège, Belgium. paoloemiliosimoni@gmail.com. 3. Radiology Department, "Reine Fabiola" Children's University Hospital, 15, Avenue Jean Joseph Crocq, 1020, Brussels, Belgium. Marco.grumolato@gmail.com. 4. Rheumathology Department, Univesity of Liège, Avenue de l'Hopital 11-Bât B34, 4000, Liège, Belgium. 5. Radiology Department, "Reine Fabiola" Children's University Hospital, 15, Avenue Jean Joseph Crocq, 1020, Brussels, Belgium. 6. University of Liège, University library «Bibliothèque des Sciences de la Vie», Avenue de l'Hopital 11-Bât B34, 4000, Liège, Belgium.
Abstract
AIM: To perform a systematic review to establish whether blind injections of the gleno-humeral (GHJ) joint may be an accurate alternative to injections performed imaging guidance, considering multiple anatomical approaches. MATERIALS AND METHODS: Our search strategy yielded 478 articles for Scopus, 815 articles for MEDLINE, 128 articles for Cochrane Central Register of Controlled Trials and 555 articles for Embase until May 2016. One hundred and sixty-seven abstracts were retrieved after duplicates removal. Two readers independently reviewed all the 1067 abstracts. They selected for the full-text analysis only the abstracts in which the accuracy of intra-articular position of the needle was confirmed on imaging (humans) or by a surgical dissection (cadavers). Thirty-eight studies were eventually selected for the full-text reading and data extraction. The selected studies included a total of 2309 patients (2690 shoulders) and 195 cadavers (299 shoulders). To objectively assess the methodological quality of the present systematic review, "Assessment of Multiple Systematic Review" (AMSTAR) tool was used. RESULTS: The overall accuracy of the intra-articular injection in GHJ varied from 42 to 100% in the 38 selected studies. Imaging guidance was used in 65% of articles and the overall accuracy of guided GHJ injections was higher than blind injection. However, five articles in which blind injection the GHJ was used (159 shoulders) reported accuracy as high as 100%. CONCLUSION: A comprehensive review of the literature confirms that guided injections of the GHJ have overall accuracy higher compared to blind injection. Nevertheless, in some studies, including a relatively large number of shoulders, blind injections have been proven to be 100% accurate. Hence, blind injections of GHJ could be proposed a cost-effective alternative to imaging-guided injection. A large prospective randomized study is needed to gauge this hypothesis and compare the cost-effectiveness of these two techniques for the most common anatomical approaches.
AIM: To perform a systematic review to establish whether blind injections of the gleno-humeral (GHJ) joint may be an accurate alternative to injections performed imaging guidance, considering multiple anatomical approaches. MATERIALS AND METHODS: Our search strategy yielded 478 articles for Scopus, 815 articles for MEDLINE, 128 articles for Cochrane Central Register of Controlled Trials and 555 articles for Embase until May 2016. One hundred and sixty-seven abstracts were retrieved after duplicates removal. Two readers independently reviewed all the 1067 abstracts. They selected for the full-text analysis only the abstracts in which the accuracy of intra-articular position of the needle was confirmed on imaging (humans) or by a surgical dissection (cadavers). Thirty-eight studies were eventually selected for the full-text reading and data extraction. The selected studies included a total of 2309 patients (2690 shoulders) and 195 cadavers (299 shoulders). To objectively assess the methodological quality of the present systematic review, "Assessment of Multiple Systematic Review" (AMSTAR) tool was used. RESULTS: The overall accuracy of the intra-articular injection in GHJ varied from 42 to 100% in the 38 selected studies. Imaging guidance was used in 65% of articles and the overall accuracy of guided GHJ injections was higher than blind injection. However, five articles in which blind injection the GHJ was used (159 shoulders) reported accuracy as high as 100%. CONCLUSION: A comprehensive review of the literature confirms that guided injections of the GHJ have overall accuracy higher compared to blind injection. Nevertheless, in some studies, including a relatively large number of shoulders, blind injections have been proven to be 100% accurate. Hence, blind injections of GHJ could be proposed a cost-effective alternative to imaging-guided injection. A large prospective randomized study is needed to gauge this hypothesis and compare the cost-effectiveness of these two techniques for the most common anatomical approaches.
Entities:
Keywords:
Arthrography; Cadavers; Fluoroscopy; Humans; Injections; Intra-articular/methods; Magnetic resonance imaging; Reproducibility of results interventional; Shoulder joint; Ultrasonography