ISSN: 1309 - 3843 E-ISSN: 1307 - 7384
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ORIJINAL ARAŞTIRMA

Omuz Subakromiyal Sıkışma Sendromlu Hastalarda Ultrason Eşliğinde Yapılan Subakromiyal, Akromiyoklavikular ile Subakromiyal Enjeksiyon ve Supraskapular Sinir Bloğunun Etkinliğinin Karşılaştırılması: Randomize Kontrollü, Tek Kör, Klinik Çalışma
Comparison of the Effectiveness of the Ultrasound- Guided Subacromial, Acromioclavicular with Subacromial Injection and Suprascapular Nerve Block in Patients with Shoulder Subacromial Impingement Syndrome: A Randomized Controlled, Single Blind, Clinical T
Received Date : 31 Mar 2023
Accepted Date : 28 Aug 2023
Available Online : 11 Sep 2023
Doi: 10.31609/jpmrs.2023-97168 - Makale Dili: EN
J PMR Sci 2024;27(1):40-8.
ÖZET
Amaç: Subakromiyal sıkışma sendromunun [subacromial impingement syndrome (SIS)] ana girişimsel tedavi teknikleri, subakromiyal (SA) enjeksiyonu ve supraskapular sinir bloğudur [suprascapular nerve block (SSNB)]. Ayrıca akromiyoklavikular eklem [acromioclavicular joint (ACJ)] patolojileri SIS ile ortak bir etiyolojik faktör olabilir ve tedavi yönetiminde dikkate alınmalıdır. Bu çalışmada, SIS tedavisinde SA enjeksiyonu, ACJ ve SA enjeksiyonu (ACJ+SA) ve SSNB’nin etkinliğinin araştırılması amaçlandı. Gereç ve Yöntemler: Bu prospektif, randomize, kontrollü çalışma, SIS ile ilişkili kronik omuz ağrısı olan 90 hastayı içermektedir. Hastalar 3 gruba; Grup SA (n=30) ultrason (US) eşliğinde SA enjeksiyonu, Grup SA+ACJ (n=30) US eşliğinde SA+ACJ enjeksiyonu ve Grup SSNB (n=30) US eşliğinde SSNB enjeksiyonu yapılan gruplar olarak ayrıldı. İzlem parametreleri, tedavi öncesi ve tedavi sonrası 2, 4, 12 ve 24. haftalarda ölçülen görsel analog skala [visual analogue scale (VAS)], Omuz Ağrısı ve Disabilite İndeksi [Shoulder Pain and Disability Index (SPADI)] ve Kısa Form-12 [Short Form-12 (SF-12)] skorlarıydı. Bulgular: SA+ACJ ve SSNB gruplarında tedavi sonrası tüm ölçüm zamanlarında VAS ve SPADI skorları tedavi öncesine göre istatistiksel olarak anlamlı derecede düşük bulundu (p<0,001). Grup SA’nın 24. hafta takiplerinde her iki ölçüm skorlarında düşüş devam etmedi (p>0,05). Her üç grubun SF-12 puanları tüm ölçüm zamanlarında başlangıca göre anlamlı olarak yüksek bulundu (p<0,001). Sonuç: Bu çalışmanın bulguları, SA, SA+ACJ enjeksiyonu ve SSNB uygulamasının SIS tanılı hastalarda kısa dönemde ağrı, fonksiyon ve yaşam kalitesi üzerine olumlu etkilerinin olduğunu, uzun dönem takiplerde ise sadece SA+ACJ enjeksiyonu ve SSNB etkinliğini koruduğunu düşündürmektedir.
ABSTRACT
Objective: The main interventional therapeutic techniques of subacromial impingement syndrome (SIS) are subacromial (SA) injection and suprascapular nerve block (SSNB). Also, acromioclavicular joint (ACJ) pathologies may be a common etiological factor with SIS and should be considered in treatment management. This study aimed to investigate the efficacy of SA injection, ACJ and SA injection (ACJ+SA), and SSNB in the treatment of SIS. Material and Methods: This prospective, randomized, controlled trial included 90 patients with chronic shoulder pain associated with SIS. The patients were divided into three groups: Group SA (n=30) receiving ultrasound (US)-guided SA injection, Group SA+ACJ (n=30) receiving US-guided SA+ACJ injection, and Group SSNB (n=30) receiving US-guided SSNB. Follow-up parameters were visual analogue scale (VAS), Shoulder Pain and Disability Index (SPADI) and Short Form-12 (SF-12) scores measured before treatment and at the posttreatment 2nd week, 4th, 12th and 24th week. Results: In SA+ACJ and SSNB groups, VAS and SPADI scores were found to be statistically significantly lower than before treatment at all measurement times after treatment (p<0.001). The decrease in both measurement scores did not continue at the 24th week follow-up of Group SA (p>0.05). The SF-12 scores of all three groups were significantly higher than the baseline at all measurement times (p<0.001). Conclusion: The findings of this study suggest that SA, SA+ACJ injection and SSNB application have positive effects on pain, function and quality of life in patients with SIS in the short term, while only SA+ACJ injection and SSNB maintain their effectiveness in long-term follow-ups.
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