Effectiveness of Ultrasound-Guided Versus Anatomic Landmark-Guided Corticosteroid Injection on Pain, Physical Function, and Safety in Patients With Subacromial Impingement Syndrome: A Systematic Review and Meta-analysis.

Only 12 randomized trials were included, and most had unclear or high risk of bias. The certainty of evidence ranged from moderate to very low, depending on the outcome. Pain and function results showed statistically significant heterogeneity, so the trials varied widely in their findings. Publication bias was suspected for function. Safety was reported in only 6 studies, so adverse event rates are uncertain. Follow-up was from 1 to 12 wks, so longer-term effects are not shown. The definition of subacromial impingement varied across studies. Searches were limited to English and Chinese. Pain outcomes were converted to a 10-point scale, and some pain outcomes were unspecified. The injection approach varied across studies.

The authors reported that financial disclosure statements were obtained and that no conflicts of interest were reported by the authors or by any individuals in control of the content.

Do not read the significant pain and function results as proof that ultrasound guidance clearly improves all outcomes. The pain difference was small, the function evidence was very low certainty, and shoulder range of motion did not differ overall.