Evaluación del tratamiento con infiltraciones intraarticulares en la patología osteoarticular del hombro en atención primaria / Evaluation of treatment with intra-articular injections in osteoarticular pathology of the shoulder in primary care

Objetivo principal: Evaluar la respuesta clínica a las 24semanas de la infiltración, medida como alivio del dolor y recuperación funcional, en el síndrome de hombro doloroso (SHD) en atención primaria (AP). Diseño: Serie de casos longitudinal con tratamiento de inyección en la articulación escapulohumeral; se describen la funcionalidad y la evolución del dolor previa y a las 24semanas postinfiltración. Emplazamiento: Atención Primaria. Centro de salud no urbano. Participantes: Pacientes con patología osteoarticular de hombro susceptible de infiltración, fracaso de tratamiento farmacológico y calificación en la escala analógica visual (EVA) ≥4 o Constant Score (CS) ≤70. Intervenciones: Inyección intraarticular corticosteroide y anestésico local en la articulación escapulohumeral, describiendo su evolución a 1, 4, 12 y 24semanas postinfiltración. Mediciones principales: Respuesta de la infiltración según EVA antes-después, CS antes-después, número de infiltraciones, efectos secundarios, incapacidad laboral transitoria (ILT). Resultados: Se infiltraron 66 pacientes, edad media 51,1años (DE: 14,7), 57,6% mujeres, 63,3% infiltración hombro derecho. El 22,7% precisaron ILT y cursaron alta con una mediana de 14días (rango de 7-56días). Precisaron una infiltración (80,3%) y la patología infiltrada más frecuente fue la tendinitis de los rotadores (90,9%). Sufrieron efectos secundarios leves un 9,4%. Encontramos disminución de dolor de severo a leve y una mejoría funcional de pobre a buena. Las variables: ser jubilado (OR: 37,82, p=0,001) y tener un puntaje EVA previo a la infiltración >8 (OR; 15,67, p=0,055, cuasi significativo) se asociaron a mala respuesta. Conclusiones: La administración intraarticular de corticosteroides en el SHD disminuye el dolor y aporta una mejoría funcional tras la primera semana postinfiltración, manteniéndose a largo plazo.(AU)

Main objective: To evaluate the clinical response at 24weeks after injection, measured as pain relief and functional recovery, in painful shoulder syndrome (PSS) in primary care (PC). Design: Longitudinal case series with injection treatment in the scapulohumeral joint, describing functionality and pain evolution before and at 24weeks post injection. Location: Non-urban primary care centres. Participants: Patients with osteoarticular shoulder pathology susceptible to injection, failure of pharmacological treatment and rating on the visual analogue scale (VAS) ≥4 or constant score (CS) ≤70. Interventions: Intra-articular injection of corticosteroid and local anaesthetic into the scapulohumeral joint, describing its evolution at 1, 4, 12 and 24weeks post injection. Main measurements: Infiltration response according to EVA before and after, CS before and after, number of infiltrations, side effects, temporary inability to work (TIL). Results: Sixty-six patients receiving injection, mean age 51.1years (SD 14.7), 57.6% were women and 63.3% were injection in the right shoulder. A 22.7% required TIL and were discharged with a median of 14days (range 7-56days). They required an injection (80.3%) and the most frequent injection pathology was rotator cuff tendinitis (90.9%). They suffered mild side effects (9.4%). We found a decrease in pain from severe to mild and a functional improvement from poor to good. The variables: being retired (OR: 37.82, P=.001) and having an EVA score prior to injection >8 (OR: 15.67, P=.055, almost significant) were associated with poor response. Conclusions: Intra-articular administration of corticosteroids in PSS reduces pain and provides functional improvement after the first week after injection, and is maintained in the long term. This allows a quick recovery to work after an injection at two weeks reducing recovery time by 50%, with few side effects.

[Evaluation of treatment with intra-articular injections in osteoarticular pathology of the shoulder in primary care]. / Evaluación del tratamiento con infiltraciones intraarticulares en la patología osteoarticular del hombro en atención primaria.

MAIN OBJECTIVE: To evaluate the clinical response at 24weeks after injection, measured as pain relief and functional recovery, in painful shoulder syndrome (PSS) in primary care (PC). DESIGN: Longitudinal case series with injection treatment in the scapulohumeral joint, describing functionality and pain evolution before and at 24weeks post injection. LOCATION: Non-urban primary care centres. PARTICIPANTS: Patients with osteoarticular shoulder pathology susceptible to injection, failure of pharmacological treatment and rating on the visual analogue scale (VAS) ≥4 or constant score (CS) ≤70. INTERVENTIONS: Intra-articular injection of corticosteroid and local anaesthetic into the scapulohumeral joint, describing its evolution at 1, 4, 12 and 24weeks post injection. MAIN MEASUREMENTS: Infiltration response according to EVA before and after, CS before and after, number of infiltrations, side effects, temporary inability to work (TIL). RESULTS: Sixty-six patients receiving injection, mean age 51.1years (SD 14.7), 57.6% were women and 63.3% were injection in the right shoulder. A 22.7% required TIL and were discharged with a median of 14days (range 7-56days). They required an injection (80.3%) and the most frequent injection pathology was rotator cuff tendinitis (90.9%). They suffered mild side effects (9.4%). We found a decrease in pain from severe to mild and a functional improvement from poor to good. The variables: being retired (OR: 37.82, P=.001) and having an EVA score prior to injection >8 (OR: 15.67, P=.055, almost significant) were associated with poor response. CONCLUSIONS: Intra-articular administration of corticosteroids in PSS reduces pain and provides functional improvement after the first week after injection, and is maintained in the long term. This allows a quick recovery to work after an injection at two weeks reducing recovery time by 50%, with few side effects.

Escalas de gravedad en las unidades de cuidados intensivos: ¿instrumentos de utilidad clínica o de gestión? / Severity of illness scales in intensive care units: clinical or management usefulness?

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