***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Blind injection of the subacromial-sub-deltoid bursa ( SSB ) for diagnostic purpose s ( Neer test ) or therapeutic purpose s ( corticosteroid therapy ) is frequently used . Poor response to previous blind injection or side effects may be due to a misplaced injection . It is assumed that ultrasound (US)-guided injections are more accurate than blind injections . In a r and omized study , we compared the accuracy of blind injection to that of US-guided injection into the SSB . Patients and methods 20 consecutive patients with impingement syndrome of the shoulder were r and omized for blind or US-guided injection  in the SSB . Injection was performed either by an experienced orthopedic surgeon or by an experienced musculoskeletal radiologist . A mixture of 1 m’L methylprednisolone acetate , 4 mL prilocaine hydrochloride and 0.02 mL ( 0.01 mmol ) Gadolinium DTPA was injected . Immediately after injection , a 3D-gradient T1-weighted magnetic resonance scan of the shoulder was performed . The location of the injected fluid was independently assessed by 2 radiologists who were blinded as to the injection technique used . Results The accuracy of blind and US-guided injection was the same . The fluid was injected into the bursa in all cases . Interpretation Blind injection into the SSB is as reliable as US-guided injection and could therefore be used in daily routine . US-guided injections may offer a useful alternative in difficult cases , such as with changed anatomy postoperatively or when there is no effective clinical outcome BACKGROUND Ultrasound is a useful adjunct to many Emergency Department ( ED ) procedures . Arthrocentesis is typically performed using a l and mark technique but ultrasound may provide an opportunity to improve arthrocentesis performance . OBJECTIVE To assess the success of emergency physicians performing l and mark ( LM ) vs. ultrasound (US)-guided knee arthrocentesis techniques . METHODS This was a prospect i ve , r and omized , controlled study of patients requiring knee arthrocentesis who presented to one urban university ED and two community EDs between June 2005 and February 2007 . RESULTS There were 66 patients enrolled ( 39 US-guided , 27 LM ) . Among all users , there was no difference in arthrocentesis success ( US 37/39 vs. LM 25/27 ) ; p = 1.0 . SECONDARY ENDPOINTS : 1 ) Patients reported less pain with ultrasound ; US-guided 3.71 ( 95 % confidence interval [ CI ] 2.61 - 4.80 ) cm vs. LM 5.19 ( 95 % CI 3.94 - 6.45 ) cm ; p = 0.02 . 2 ) Providers felt the US-guided technique was easier to perform than LM ; 1.67 units on 5-point scale ( 95 % CI 1.37 - 1.97 ) vs. 2.11 ( 95 % CI 1.79 - 2.42 ) units ; p = 0.02 . 3 ) The total procedure time was shorter with the US-guided technique ; 10.58 ( 95 % CI 7.36 - 13.80 ) min vs. LM 13.37 ( 95 % CI 9.83 - 16.92 ) min ; p = 0.05 . 4 ) There was no difference in the amount of fluid obtained between techniques ; US-guided 45.33 ( 95 % CI 35.45 - 55.21 ) mL vs. LM 34.7 ( 95 % CI 26.09 - 43.32 ) mL ; p = 0.17 . CONCLUSION US-guided knee arthrocentesis technique does not improve overall success of obtaining joint fluid aspirate vs. the st and ard LM and palpation technique . An US-guided approach does not result in more pain for the patient , takes no additional time to perform and , at least for novice physicians , leads to more fluid aspiration and greater novice provider confidence with the procedure . Further studies with more participants and st and ardization of anesthetic quantity are required to vali date these findings OBJECTIVE The purpose of this study was to investigate the feasibility of using real-time high-resolution sonography to guide an injection needle into the intra-articular space within the knee . METHODS Eighty-nine patients with radiographically confirmed knee osteoarthritis ( Kellgren-Lawrence grade 2 or 3 ) without an effusion were included . After sonographically guided or blind injection of hyaluronic acid ( HA ) and contrast dye through a medial patellar portal ( MPP ) into the knee joint , a radiographic image was made to ascertain whether the injected material had reached the intra-articular space . RESULT Sonographically guided injections of HA into the knee joint had a significantly greater accuracy rate ( 95.6 % ) than blind injections ( 77.3 % ; P = .01 ) . CONCLUSIONS Intra-articular injections via an MPP using sonographic guidance may raise the accuracy rate in knee joint injections OBJECTIVE To compare the interobserver reliability of three-dimensional ( 3D ) volumetric ultrasonography ( US ) and 2D real-time US in detecting inflammatory and destructive changes in rheumatoid arthritis ( RA ) wrist and h and . METHODS Two RA patients were selected by a rheumatologist who performed independently a grey-scale and power Doppler ( PD ) volumetric acquisition at three anatomic sites in their more symptomatic wrist/h and using two identical scanners equipped with 3D volumetric probe . Twelve rheumatologists expert in MSUS were r and omly assigned to a US scanner and a patient . In the first part of the study , each group of experts blindly , independently , and consecutively performed a 2D real-time grey-scale and PD US investigation of inflammatory changes and /or bone erosions at the three anatomic sites . In the second part of the study , each group of investigators blindly evaluated the same pathologic changes in the 6 volumes from the patient not scanned by them . RESULTS The kappa values were higher for 3D volumetric US than for 2D US in the detection of synovitis/tenosyno-vitis ( 0.41 vs. 0.37 ) and PD signal ( 0.82 vs 0.45 ) and in the PD signal grading ( 0.81 vs. 0.55 ) . CONCLUSION 3D volumetric US may improve the interobserver reliability in RA multicentre studies OBJECTIVE Most corticosteroid injections into the joint are guided by the clinical examination ( CE ) , but up to 70 % are inaccurately placed , which may contribute to an inadequate response . The aim of this study was to investigate whether ultrasound ( US ) guidance improves the accuracy and clinical outcome of joint injections as compared with CE guidance in patients with inflammatory arthritis . METHODS A total of 184 patients with inflammatory arthritis and an inflamed joint ( shoulder , elbow , wrist , knee , or ankle ) were r and omized to receive either US-guided or CE-guided corticosteroid injections .  Visual analog scales ( VAS ) for assessment of function , pain , and stiffness of the target joint , a modified Health Assessment Question naire , and the EuroQol 5-domain question naire were obtained at baseline and at 2 weeks and 6 weeks postinjection . The erythrocyte sedimentation rate and C-reactive protein level were measured at baseline and 2 weeks . Contrast injected with the steroid was used to assess the accuracy of the joint injection . RESULTS One-third of CE-guided injections were inaccurate . US-guided injections performed by a trainee rheumatologist were more accurate than the CE-guided injections performed by more senior rheumatologists ( 83 % versus 66 % ; P = 0.010 ) . There was no significant difference in clinical outcome between the group receiving US-guided injections and the group receiving CE-guided injections . Accurate injections led to greater improvement in joint function , as determined by VAS scores , at 6 weeks , as compared with inaccurate injections ( 30.6 mm versus 21.2 mm ; P = 0.030 ) . Clinicians who used US guidance reliably assessed the accuracy of joint injection ( P < 0.001 ) , whereas those who used CE guidance did not ( P = 0.29 ) . CONCLUSION US guidance significantly improves the accuracy of joint injection , allowing a trainee to rapidly achieve higher accuracy than more experienced rheumatologists . US guidance did not improve the short-term outcome of joint injection Aim To compare the effectiveness of l and mark-guided local injections and ultrasonography ( USG ) guided injections for shoulder pain . Methods A total 60 consecutive patients with shoulder pain due to soft tissue disorders was enrolled , and r and omly assigned to receive triamcinolone ( 40 mg ) either by l and mark-guided ( LMG , n=30 ) or USG guided ( n=30 ) injection . The patients were evaluated on admission and 6 weeks after the injection . Clinical assessment included demographic and clinical data , a visual analoge scale ( VAS ) for pain ( 0 to 10 cm ) , the Constant scale ( 0 to 100 ) for function , passive and active shoulder range of motion ( ROM ) with goniometric evaluation , and postinjection adverse effects . Results Initial demographic , clinical and USG findings in the groups exhibited no significant differences . Six weeks after injection , the VAS and the Constant score showed a significantly better improvement in USG group compared with LMG group ( mean VAS score decrease : 4.0±1.7 for USG vs. 2.2±0.9 for LMG , P<0.05 ; mean Constant score change : 32.2 for USG vs. 12.2 for LMG , P<0.05 ) . Significant improvements were observed in active and passive ROM values in both groups , USG group values being better . Initially 18 patients in LMG and 24 patients in USG had limited shoulder ROM , of which 6 was returned to normal values in LMG group and 12 in USG group at 6 week after injection ( P<0.05 ) . Conclusions Our results indicate that the injection of corticosteroids to patients with shoulder pain due to soft tissue disorders under the USG-guidance may improve therapeutic effectiveness and reduce adverse effects OBJECTIVE The purpose of this investigation was to describe a technique for sonographically guided proximal tibiofibular joint ( PTFJ ) injections  and compare its accuracy with that of palpation guided injections in a cadaveric model . METHODS A single experienced operator completed 12 sonographically guided and 12 palpation guided PTFJ injections in unembalmed cadavers . The injection order was r and omized , and all injections were completed with diluted colored latex . Coinvestigators blinded to the injection technique dissected each specimen and grade d the colored latex location as accurate ( in the PTFJ ) , accurate with overflow ( within the PTFJ but also in other regions ) , or inaccurate ( no latex in the joint ) . For statistical analysis , all injections placing latex within the PTFJ were considered " accurate , " whereas " inaccurate " injections result ed in no PTFJ latex . RESULTS All 12 sonographically guided PTFJ injections accurately placed latex into the PTFJ ( 100 % accuracy ) , whereas only 7 of 12 palpation guided injections ( 58 % ) placed latex within the PTFJ ( P = .01 ) . All 5 inaccurate palpation guided injections were superficial and inferior to the PTFJ . Four of 12 accurate sonographically guided PTFJ injections ( 33 % ) showed some overflow into the adjacent anterior musculature , whereas 5 of the accurate palpation guided injections ( 42 % ) result ed in overflow into the anterior musculature ( 1 ) , knee joint ( 2 ) , or both ( 2 ) . CONCLUSIONS This cadaveric investigation suggests that sonographic guidance can be used to inject the PTFJ with a high degree of accuracy and should be considered superior to palpation guidance . Clinicians should consider using sonographic guidance to inject the PTFJ for diagnostic or therapeutic purpose s when clinical ly indicated Chen MJL , Lew HL , Hsu TC , Tsai WC , Lin WC , Tang SFT , Lee YC , Hsu RCH , Chen CPC : Ultrasound-guided shoulder injections in the treatment of subacromial bursitis . Am J Phys Med Rehabil 2006;85:31–35 . Objective : To investigate the treatment effectiveness between ultrasound-guided and blind injection techniques in the treatment of subacromial bursitis . Design : A total of 40 patients with sonographic confirmation of subacromial bursitis were recruited into this study . These patients were divided into blind and ultrasound-guided injection groups . The shoulder abduction range of motion was compared before injections and 1 wk after the completion of injections in both groups . Results : The shoulder abduction range of motion before injection in the blind injection group was 71.03 ± 12.38 degrees and improved to 100 ± 18.18 degrees 1 wk after the injection treatments . However , the improvement did not reveal significant statistical differences ( P > 0.05 ) . The shoulder abduction range of motion before injection in the ultrasound-guided injection group was 69.05 ± 14.72 degrees and improved to 139.29 ± 20.14 degrees 1 wk after the injection treatments ( P 
    Output:
    
RESULTS Accuracy was greater in the ultrasound-guided group , independent of anatomic site .
An improvement in time to symptom onset in the short term ( < 6 weeks ) was greatest with the use of ultrasound-guided intra-articular injection .
Long-term outcomes are not proven to be different between intra-articular injection with ultrasound or anatomic guidance .
The greatest trends were observed in the knee and shoulder joints , demonstrating improvements in function , pain , intensity , and range of motion , independent of injection technique .
In foot/ankle and wrist/h and , small joint space injections showed a greater accuracy with ultrasound-guided injections contrasted to larger joint spaces , in which these joint injections demonstrated equal accuracy independent of injection technique .
This systematic review can confirm that accuracy is improved with the use of ultrasound-guided intra-articular injection .
We can also confirm that short-term outcome improvements are present using ultrasound-guided injection techniques but can confirm no difference in long-term outcome measures using either technique