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.

Artrografía de las extremidades, ¿cómo se hace? / Arthrography of Extremities, How is it Done?

La artrografía, a pesar de ser una técnica antigua, ha recobrado validez en los últimos años por su utilidad en la evaluación de estructuras que no se pueden valorar correctamente mediante técnicas de imagen no invasivas. El propósito de este artículo es realizar una revisión de las técnicas de artrografía por fluoroscopia de las principales articulaciones en las extremidades (hombro, codo, muñeca, cadera, rodilla y tobillo), con el fin de brindar al lector múltiples abordajes para cada una de ellas, con base en la anatomía articular.

Arthrography, despite being an old technique, has regained validity in recent years due to its usefulness in the assessment of structures that cannot be correctly assessed using non-invasive imaging techniques. The purpose of this article is to review the fluoroscopic arthrography techniques of the main joints in the extremities (shoulder, elbow, wrist, hip, knee and ankle), in order to provide the reader with multiple approaches for each of them, based on articular anatomy.