Discussion
volume SCI, circumoral paresthesia, seizures, slurred speech, allergy, impingement, cardiac arrest, muscular imbalance, tinnitus, NSIAD, extraarticular, researchFor subacromial impingement syndrome, pain, depressed
SUBACROMIAL IMPINGEMENT SYNDROME, CARDIAC ARRHYTHMIAS, INFLAMMATORY RESPONSES, RESPIRATORY ARREST, ALLERGY, CARDIAC ARREST, TINNITUS, ADVERSE EFFECTS, SECONDARY, BLIND, SHOULDER IMPINGEMENT SYNDROME, VASOVAGAL SYNCOPE, COMPLICATIONS
The VLVCI group's outcome was similar to that of the HVCI group's, indicating that it might be used routinely in treating subacromial impingement syndrome. We found that the VLVCI had the same therapeutic and diagnostic effect as those of the HVCI, which has been a commonly used standard in general orthopedics. It was found that for the VLVCT group, 15 min post-injection of HVCI of mixed lidocaine solution, lidocaine overdose in blood serum could cause allergy, vasovagal syncope, or severe consequence complications. The difference in the VAS percentage after 15 min was not significant, indicating that the VLVCI could be used as an impingement test in the same way that a traditional impingement test with a main lidocaine solution component would be used. There has never been a study comparing VLVCI or pure corticosteroid without a mixed anesthetic solution. This is the first study to use VLVCI to increase the most potential steroid concentration effect, while avoiding the complications associated with lidocaine, the main component of HVCI and other different volume SCI comparative studies.Because the cause of SIS, both intrinsic and extrinsic, is anatomical structural changes that affect the subacromial space, the rehabilitation program is initiated as the first choice of treatment. Especially with secondary impingement, which is primarily caused by muscular imbalance, a rehabilitation program that includes exercise therapy (therapeutic exercise) and manual therapy will encourage patients to maintain and restore normal ROM of the shoulder girdle, which includes glenohumeral mobilization techniques, motor control exercises, scapular stabilization, and stretchingTriamcinolone acetonide (TMC) is a kind of corticosteroid that is commonly used in orthopedic procedures. Through reducing inflammatory mediators and influencing the cells engaged in inflammatory responses, the therapeutic effects affected both anti-inflammation and direct analgesic benefitsThe signs and symptoms of lidocaine intoxication, which rely on plasma levels larger than 5 mcg/ml, include slurred speech, tinnitus, circumoral paresthesia, and feeling faint, are difficult to predict. If the concentration is higher than 10 mcg/ml, the patient may experience seizures or lose consciousness. At 15 mcg/ml, the heart and central nervous system become more depressed, leading to cardiac arrhythmias, respiratory arrest, and cardiac arrest at 20 mcg/mlMany subacromial injection plans for SIS patients, including those in this study for NSIAD, mentioned that a posterolateral blind injection approach compares 60 mg of Ketolac injection to 40 mg of triamcinolone in shoulder impingement syndrome. As the result of the ROM and functional score outcomes, the Ketolac group at 4 weeks is superior to triamcinolone in terms of UCLA shoulder rating score and active abduction (20 versus 40 respectively (P = 0.03), 134 versus 151 degrees respectively (P = 0.03)) because of the longer half-life of the drug. However, regarding effectiveness, both groups can significantly improve and achieve satisfying outcomesThe role of ultrasonography is widely used in the shoulder region, both extraarticular and intraarticular, for diagnosis, intervention, and biomechanical researchFor subacromial impingement syndrome, the clinical outcome of ultrasound-guided subacromial injections was compared to blind subacromial injections. After a short-term follow-up, blind injections into the subacromial bursa were just as successful as ultrasound-guided injections in reducing pain and function in subacromial impingement syndrome. As a result, ultrasonography guiding for subacromial injections is no longer requiredOur study's strengths include a prospective randomized control trial, long-term and short-term follow-up, and the use of a standardized and validated VAS, WORC, and DASH scores. This is the first study to compare the efficacy of corticosteroid injections in the subacromial impingement syndrome using HVCI and VLVCI (pure corticosteroid injection without analgesic solution combination). Data regarding all possible adverse effects were also collected. The follow-up rate was of a reasonably standard range, at approximately 85 percent in both of groups. We only had one patient that we were unable to include, due to the patient's decision to undergo the procedure on her own. Across all samples, less than 5 percent of participants to dropped out. In treatment of subacromial impingement syndrome. The follow-up period was short to long-term (6 months). Hence, the long-term effectiveness and adverse effects of treatment could be assessed.The study's limitations were that firstly, the blinding technique was ineffective, as only assessors were used, and secondly, the trial was single-blinded, which may have resulted in underpowering for the primary and secondary outcomes. Different surgeons administered the corticosteroid injections. Although some publications suggested that low-volume corticosteroid injection (less than 5 ml) be utilized with the USG technique in low-CI, in order to improve the outcome, we only had a limited medical device and landmark guide injection was still a widespread practice among orthopedists in routine practice. Moreover, the lack of ultrasound guidance so the precise positioning of the injection is unclear.