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Rotator Cuff Impingement: Correlation Between Findings on MRI and Outcome After Fluoroscopically Guided Subacromial Bursography and Steroid Injection

¹ Department of Radiology, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland.
² Department of Radiology, Cappagh National Orthopaedic Hospitals, Dublin, Ireland.
³ School of Public Health and Population Science, University College Dublin, Dublin, Ireland.

OBJECTIVE. The purpose of this study was to describe the use of fluoroscopically guided subacromial bursography in the management of rotator cuff impingement and to correlate clinical outcome with preprocedural MRI findings.

MATERIALS AND METHODS. Sixty-nine patients with clinically and MRI proven subacromial impingement referred for fluoroscopic subacromial bursography and steroid injection between January 2004 and January 2006 were included in the study. After contrast-enhanced bursography, each patient received an injection of 80 mg of methylprednisolone and 1–2 mL of 0.25% bupivacaine into the bursa. Outcome was determined retrospectively and classified as complete resolution of symptoms, partial resolution of symptoms, or no change. MRI findings of impingement were graded according to severity. Outcome was evaluated as complete resolution and as complete or partial resolution in relation to MRI findings, duration of symptoms, age, and sex.

RESULTS. Complete resolution of symptoms was recorded in 40 (58%) of the patients. Fifty-seven (83%) of the patients reported some relief of symptoms after a mean follow-up period of 6 months. Shorter duration of symptoms and minor-grade MRI findings were associated with complete resolution. Younger age and minor-grade MRI findings were associated with complete or partial resolution.

CONCLUSION. Imaging-guided subacromial steroid injection may be of benefit in the short-term management of clinically and MRI-proven subacromial impingement, with 83% of 69 patients reporting symptom relief at 6-month follow-up evaluation. Patients with shorter duration of symptoms and minor-grade MRI findings have improved outcome.

Keywords: MRI • rotator cuff • rotator cuff impingement • subacromial bursitis • subacromial bursography

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