Comparing Two Methods of Subacromial Space Injection

Subacromial shoulder injections can be approached from the front or side of the shoulder. The investigators are comparing both methods, to find which one has better spread in the subacromial space.

Both lateral and posterio-lateral methods of subacromial injections are widely used for diagnostic and therapeutic purposes. It is not known which method allows the most accurate access into the subacromial space and is more effective. The investigators have been using a novel approach from the anterior aspect of the shoulder for years with good clinical effect and propose comparing this approach to the described approach. This study will indicate which method is best and will be of practical clinical importance. The investigators feel the technique is easier to perform than other described methods and could be taught to clinicians throughout the country and adopted as the standard approach.

The participants will go for an X ray following injection which contains a radio-opaque dye to demonstrate the spread of injected material (Local anaesthetic, depomedrone and Niopam dye) in the subacromial space. A blinded radiologist will read the radiographs and scale the distribution of dye from 1 to 4 depending on the location of radiopaque dye.

The participants will fill a visual analog score before and after injection to assess the pain relief after injection.

Inclusion Criteria: Shoulder pain for at least 6 weeks duration along the lateral aspect of the shoulder. Positive impingement signs. Exclusion Criteria: History of compensation claim due to shoulder problems. Allergy to radiographic dye. Recent shoulder fracture. Bleeding disorder. Previous shoulder surgery.

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