Browsing by Author "Akbari, Najibeh"

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    Ultrasonografi eşliğinde yapılan subakromiyal steroid enjeksiyonu ile körleme yapılan subakromiyal steroid enjeksiyonu etkililiğinin karşılaştırılması
    (Başkent Üniversitesi Tıp Fakültesi, 2017) Akbari, Najibeh; Çetin, Nuri
    Omuz ağrısının en sık sebebi subakromiyal sıkışma sendromudur (SASS). Birçok çalışma ile SASS’ta steroid enjeksiyonunun faydası gösterilmiş olsa da enjeksiyon yeri ve enjeksiyonun uygulanış yöntemi açısından çalışmalar arasında farklılıklar bulunmaktadır. Bizim çalışmamızın amacı SASS hastalarında ultrason (US) eşliğinde yapılan steroid enjeksiyonunun klinik iyileşme, ağrı, fonksiyonel durum açısından körleme omuz steroid enjeksiyonu ile karşılaştırmak, hangi uygulamanın daha etkin ve güvenilir olduğuna karar vermektir. SASS tanılı toplam 29 hasta 2 gruba randomize edildi: 14 hastaya US eşliğinde subakromiyal steroid enjeksiyonu (US eşliğinde enjeksiyon grubu - UEE), 15 hastaya da körleme subakromiyal steroid enjeksiyonu yapıldı (körleme enjeksiyon grubu - KE) KE grubunda 1 hasta takibi bıraktı. Enjeksiyon öncesi ve 4 hafta sonrasında vizüel analog skala (VAS), aktif fleksiyon eklem hareket açıklığı (EHA), aktif abdüksiyon EHA, Constant- Murley skoru ve Disability of the Arm, Shoulder, Hand (DASH) skoru elde edildi. VAS skoru KE grubunda başlangıçta 8,5 (4-10), enjeksiyondan 4 hafta sonra 2 (1- 7) (p=0,001), UEE grubunda başlangıçta 9 (4-10), enjeksiyondan 4 hafta sonra 1 (1-7) (p=0,001) olarak saptandı. Gruplar arasında VAS skoru değişimi açısından anlamlı farklılık yoktu. Aktif fleksiyon EHA; KE grubunda başlangıçta 140 (70-165), enjeksiyondan 4 hafta sonra 170 (140-180) (p=0,001), UEE grubunda başlangıçta 150 (80-170), enjeksiyondan 4 hafta sonra 180 (130-180) (p=0,001) olarak saptandı. Gruplar arasında aktif fleksiyon EHA değişimi açısından anlamlı farklılık yoktu. Aktif abdüksiyon EHA; KE grubunda başlangıçta 130 (70-160), enjeksiyondan 4 hafta sonra 170 (140-180) (p=0,001), UEE grubunda başlangıçta 150 (80-170), enjeksiyondan 4 hafta sonra 180 (135-180) (p=0,001) olarak saptandı. Gruplar arasında aktif abdüksiyon EHA değişimi açısından anlamlı farklılık yoktu. Constant-Murley skoru KE grubunda başlangıçta 37 (13-80), enjeksiyondan 4 hafta sonra 85 (53-97) (p=0,001), UEE grubunda başlangıçta 39 (19-73), enjeksiyondan 4 hafta sonra 95 (49-100) (p=0,001) olarak saptandı. Gruplar arasında Constant-Murley skoru değişimi açısından anlamlı farklılık yoktu. DASH skoru KE grubunda başlangıçta 117 (62-141), enjeksiyondan 4 hafta sonra 51 (31-83) (p=0,001), UEE grubunda başlangıçta 110 (45-145), enjeksiyondan 4 hafta sonra 35 (30-86) (p=0,001) olarak saptandı. Gruplar arasında DASH skoru değişimi açısından anlamlı farklılık yoktu. Her iki grupta da enjeksiyondan 4 hafta sonra yapılan tüm klinik değerlendirme parametrelerinde anlamlı iyileşme saptandı. Her iki grupta da enjeksiyon sonrasında herhangi bir yan etki gözlenmedi. Sonuç olarak SASS hastalarında subakromiyal körleme steroid enjeksiyonu ile US eşliğinde enjeksiyon arasında klinik değerlendirme parametreleri açısından anlamlı farklılık saptanmadı. Bu sebeple subakromiyal steroid enjeksiyonu yapılırken US kullanımının gereksiz olduğunu düşünüyoruz. The most common cause of shoulder pain is subacromial impingement syndrome (SIS). Although many studies have demonstrated the benefit of steroid injection in SIS, there are differences between studies in terms of injection site and method of administration of the injection. The aim of our study is to compare ultrasound-guided subacromial steroid injections and blind subacromial steroid injections in terms of clinical improvement, pain and functional status and to decide which application is more effective and safe. A total of 29 patients with SIS were randomized into 2 groups: 14 patients received a subacromial steroid injection with ultrasound guidance (US-guided group - UGG), and 15 patients received a subacromial steroid injection without ultrasound guidance (blind group - BG). One patient lost to follow up in BG. The visual analog scale (VAS), active flexion range of motion (ROM), active abduction ROM, Constant-Murley score and Disability of the Arm, Shoulder, Hand (DASH) score were obtained before the injection and at 4 weeks after the injection. The VAS score decreased from 8,5 (4-10) before the injection to 2 (1-7) at 4 weeks after the injection in the BG (p=0,001) and from 9 (4-10) to 1 (1-7) in the UGG (p=0,001). The decrease in the VAS score was not significantly different between the groups. Active flexion ROM increased from 140 (70-165) before the injection to 170 (140-180) at 4 weeks after the injection in the BG (p=0,001), and from 150 (80-170) to 180 (130-180) in the UGG (p=0,001). The increase in the active flexion ROM was not significantly different between the groups. Active abduction ROM increased from 130 (70-160) before the injection to 170 (140-180) at 4 weeks after the injection in the BG (p=0,001), and from 150 (80-170) to 180 (135-180) in the UGG (p=0,001). The increase in the active abduction ROM was not significantly different between the groups. The Constant-Murley score increased from 37 (13-80) before the injection to 85 (53-97) at 4 weeks after the injection in the BG (p=0,001), and from 39 (19-73) to 95 (49-100) in the UGG (p=0,001). The increase in the Constant- Murley score was not significantly different between the groups. The DASH score decreased from 117 (62-141) before the injection to 51 (31-83) at 4 weeks after the injection in the BG (p=0,001) and from 110 (45-145) to 35 (30-86) in the UGG (p=0,001). The decrease in the DASH score was not significantly different between the groups. In both groups, significant improvement was observed in all clinical evaluation parameters performed 4 weeks after injection. No side effects were observed in both groups after injections. In conclusion, there were no significant differences in clinical evaluation parameters between blind subacromial steroid injections and ultrasound-guided injections in SIS patients. For this reason, we think that ultrasound use is unnecessary when subacromial steroid injection is performed.
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    Ultrasound-guided versus blind subacromial corticosteroid and local anesthetic injection in the treatment of subacromial impingement syndrome: A randomized study of efficacy
    (2020) Akbari, Najibeh; Ozen, Selin; Senlikci, Huma Boluk; Haberal, Murat; Cetin, Nuri; 0000-0002-9950-8917; 0000-0002-7290-8558; 0000-0002-8211-4065; 32160504; AAK-4129-2021; ABC-1305-2020; R-9398-2019
    Objectives: This study aims to compare the effects of ultrasound (US)-guided and blind subacromial corticosteroid and local anesthetic (LA) injection in the treatment of subacromial impingement syndrome (SIS) on shoulder pain, range of motion (ROM), and functionality. Patients and methods: The prospective study was conducted between 01 February 2017 and 31 May 2017. A total of 29 patients with clinical findings and magnetic resonance imaging (MRI) consistent with SIS were randomized into two groups: 14 patients received US-guided subacromial corticosteroid and LA injection and 15 patients received a blind subacromial corticosteroid and LA injection. Patients were evaluated before and one month after treatment. One patient was lost to follow up. The primary outcome measure was a visual analog scale (VAS) for shoulder pain. Secondary outcomes were active shoulder ROM in flexion and abduction, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the modified Constant-Murley Score (CMS). Results: Twenty eight patients (11 males, 17 females; mean age 39.5 in the US guided group and 42.5 in the blind group: range 20 to 64 years in both groups) completed the study. There was a significant improvement in VAS for shoulder pain, active ROM, DASH questionnaire score and modified CMS in both groups four weeks after treatment (p<0.05). There was no between-group difference in VAS, ROM or DASH questionnaire scores. Following treatment, the modified CMS in the US-guided injection group was higher than in the blind injection group (p=0.02). However, when the mean change in modified CMS in the US-guided injection group was compared to that of the blind injection group, the difference was insignificant (p=0.23). Conclusion: Both US-guided and blind subacromial steroid injection improve shoulder pain, ROM, and functionality in SIS; one treatment option was not found to be superior to the other. Therefore, blind injection can be performed in clinical settings where US is not available. Equally, blind injection can also be performed in patients who have a definite diagnosis of SIS based on clinical and MRI findings.