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Mr. Hanchard replies To the Editor: The letter from Masi, et al provides interesting insights on developments and practice in this area. Their summary of their "100 person-years' experience" is thought-provoking. However, more information on their methods, presumably retrospective, of data collection and analysis is required to assess the validity of their findings. The reported absence of adverse events ("reported injection complications") and their informally-estimated blind injection "success" rates should therefore be viewed with caution. With regard to these high "success" rates, 3 aspects are of particular note. First, the doses of steroid injected varied from 30 to 80 mg Depo-Medrol® equivalent. (It is unclear whether steroid concurrently targeted at the subacromial bursa was additional to this.) At the higher dosages in particular, the possibility of systemic steroid effects means that interpretation of injection "success" as an indicator of injection accuracy is tenuous. Second, disagreement among the authors as to the incidence of concurrent subacromial bursitis (the perceived need for concurrent bursal injection varied from "rarely" to "required in majority") typifies the diagnostic difficulties that confound evaluations of injection efficacy. Third, since glenohumeral "capsulitis" tends to recover spontaneously, attribution of improvement to any uncontrolled intervention is particularly insecure. As Masi, et al imply, further research in this area is required. Like Dr. Sethi, in response1 to a recent letter by Masi, et al2 , I look forward to the "additional objective scientific data [obtained] with appropriate methodology"1 that will enable progress in this area. NIGEL C.A. HANCHARD, MSc, James Cook University Hospital, Teesside Centre for Rehabilitation Sciences, Marton Road, Middlesbrough, TS4 3BW, United Kingdom. E-mail: n.hanchard@tees.ac.uk
2. Masi AT, Driessnack RP, Yunus MB. Accuracy of intra-articular injection of the glenohumeral joint: a cadaveric study [letter]. Orthopedics 2006;29:480.
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