Scientific Session 10 — Musculoskeletal - Knee and ShoulderTuesday, May 2, 2017
1147. Efficacy of Ultrasound-Guided Proximal Biceps Tendon Sheath Steroid Injections
White C1*, Levine B1, Seeger L1, Modarresi S2, Chow K2 1. University of California, Los Angeles, CA; 2. Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
Address correspondence to C. White (firstname.lastname@example.org)
Objective: This study was designed to evaluate the efficacy of an ultrasound-guided injection of a corticosteroid and anesthetic mixture into the proximal biceps tendon sheath in patients with shoulder pain and a clinical diagnosis of proximal biceps tenosynovitis that was unresponsive to conservative treatment.
Materials and Methods: After institutional review board approval, a retrospective review of electronic medical records was performed to identify all patients who had received ultrasound-guided proximal biceps peritendinous steroid injections between 2010 and 2015. A total of 94 procedures, performed on 82 individual patients, were identified. Seven patients received two or more injections in the selected timeframe. All of the patients reported shoulder pain and had clinical findings suspicious for proximal biceps tenosynovitis, some of which had imaging findings on ultrasound or MRI to support this diagnosis. All patients were referred for the steroid injections by sports medicine or orthopedic surgery physicians. The injections were performed by either a musculoskeletal radiology attending physician, fellow, or resident using ultrasound guidance. The injections included a mixture of 40–80 mg of methylprednisolone or 10–40 mg triamcinolone combined with a few milliliters of local anesthetic (bupivacaine, ropivacaine, or lidocaine), directed into the tendon sheath of the long head of the proximal biceps tendon. Of the 82 patients identified, 72 were seen for clinical follow-up or were contacted by phone. The remaining 10 were lost to follow-up. The mean time to follow-up was 28 weeks (range, 1–180 weeks). Positive response was defined as partial or complete pain relief. Negative response was defined as minimal, unchanged, or increased level of pain. Complete biceps tendon rupture was also considered a negative response.
Results: Of the 72 patients with follow-up, 46 (64%) had a positive response to the treatment, including 10 patients with history of prior shoulder surgery (10/16, 63%), 12 patients with history of prior corticosteroid injection (12/19, 63%) and 19 patients with prior or concurrent physical therapy (19/30, 63%). The remaining 25 patients (25/72, 35%) had a negative response. Five patients (5/72, 7%) had a complete ipsilateral biceps tendon rupture at follow-up. One patient reinjured his shoulder between the injection and follow-up, so clear assessment of response could not be ascertained. The mean age of patients with a positive response was 55 years (range, 24–81 years). The mean age of patients with a negative response was 47 years (range, 21–74 years). The difference in mean age between patients with a positive response and negative response was not statistically significant.
Conclusion: Ultrasound-guided peritendinous injection of corticosteroid and anesthetic for proximal biceps tenosynovitis had a good therapeutic result in the majority of patients, with a mean of 29 weeks of pain relief. However, 7% of patients in our study experienced biceps tendon rupture after the injection. Whether ultrasound-guided biceps tendon injection influences the incidence of subsequent biceps tendon rupture remains unclear.