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SHORT AND LONG-TERM EFFICACY OF CORTISONE STERIOD INJECTION IN THE ACROMIOCLAVICULAR JOINT

Authors: T Goehre; S Bell; R van Riet;

References: Presented at SECEC 2009

Purpose
There is only one published paper on the efficacy an acromioclavicular (AC) joint cortisone injection. A prospective study was therefore established to  assess the effectiveness of a cortisone injection into a symptomatic AC joint. It was felt that the O'Brien's test for AC joint symptoms could be improved by fully adducting the arm during the test, and this was also assessed.

Material and Methods
Prospectively 58 patients were included in the study. They all had comparison of the standard O'Brien test with the new modified test, and other standard provocative AC joint tests. All patients had injection of cortisone and anaesthetic into the AC joint. To be included in the study a good response to the anaesthetic was required, with no pain on provocative AC joint testing.
The patients were initially followed up at four weeks with assessment of the response to the cortisone. The patients with good relief of pain were then followed up again a minimum 2 years from the initial injection. Assessment was made of any ongoing symptoms, and if these were related to the AC joint.

Results
Thirty seven patients (64%) failed to improve satisfactorily 4 weeks from the injection with cortisone injection. Of the remaining 16 patients one patient had a later excision of distal clavicle. Minimum 2 year follow up of the remaining 15 patients revealed that 4 had developed mild occasional pain, which did not require the use of analgesia, and all were 'good or excellent' on ASES and UCLA scores. The modified O'Brien test was more sensitive in picking up AC joint pathology than the standard test.

Conclusion
Cortisone injection for AC joint pathology is fairly ineffective, and is only beneficial in the short term in 30% of patients. However if there is short term benefit, then in most cases this continues for more than 2 years.

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