Efficacy of fluoroscopy-guided triple shoulder injection for older patients with nonspecific shoulder pain

  • Isa Cuce
  • Savas SencanEmail author
  • Fatmagul Ulku Demir
  • Ali Koc
  • Mustafa Calis
Research Paper

Key Summary Points


The study was to evaluate the effects of fluoroscopy-guided triple shoulder injection (i.e. injection into glenohumeral joint, subacromial space, and acromioclavicular joint) on pain and function in older patients with nonspecific shoulder pain.


A significant improvement was detected in pain, and function at 3 and 12 weeks after injection compared with baseline.


Fluoroscopy-guided triple shoulder injection offers a therapeutic option for older patients with nonspecific shoulder pain.



Nonspecific shoulder pain is a common complaint in older adults that impairs physical function by restricting the range of joint movement, and causing severe pain. The study evaluated the effects of fluoroscopy-guided triple shoulder injection [i.e., injection into glenohumeral (GH) joint, subacromial (SA) space, and acromioclavicular (AC) joint] on pain, function, and range of motion in older patients with nonspecific shoulder pain.


A total of 43 patients who were aged 65 years and older and diagnosed with nonspecific shoulder pain were included in this prospective, non-randomized clinical trial; 65.1% of the patients were female and mean age was 70.2 ± 5.0. Under fluoroscopic guidance, a mixture of methylprednisolone and bupivacaine was injected into the GH joint, SA space and AC joint. Patients were evaluated as per the Numeric Rating Scale for Pain (NRS-Pain), the Shoulder Pain and Disability Index (SPADI), and the active range of motion (AROM) at baseline, and again at 3 and 12 weeks after the injection.


A statistically significant improvement was detected in NRS-Pain, SPADI, and AROM at 3 and 12 weeks after injection compared with baseline. The change in SPADI score from baseline was higher than the minimal detectable change in 67.4% of patients at 12 weeks. The SPADI score at baseline was positively correlated with the post-injection SPADI score at 3 and 12 weeks.


In older patients with nonspecific shoulder pain, fluoroscopy-guided triple shoulder injection provides significant improvements in pain and physical function with low complication rates during the 12-week follow-up.


Aged Shoulder pain Injections Fluoroscopy Magnetic resonance imaging 


Compliance with ethical standards

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

The study protocol was reviewed and approved by the Erciyes University School of Medicine Human Research Ethics Committee in accordance with the Declaration of Helsinki (Reference Number: 2017/117).

Informed consent

All of the patients were informed of the study protocols in detail; provided their informed written consent.


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Copyright information

© European Geriatric Medicine Society 2019

Authors and Affiliations

  1. 1.Department of Physical Medicine and RehabilitationAdiyaman University Training and Research HospitalAdiyamanTurkey
  2. 2.Department of Physical Medicine and Rehabilitation, Division of Pain MedicineFaculty of Medicine, Marmara UniversityIstanbulTurkey
  3. 3.Department of Physical Medicine and RehabilitationKayseri City HospitalKayseriTurkey
  4. 4.Department of RadiologyKayseri City HospitalKayseriTurkey
  5. 5.Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of MedicineErciyes UnıversityKayseriTurkey

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