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Wellbeing & Health MSK Clinics Clinical Evidence Library
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Clinical Evidence Library

A central route into the clinician-facing evidence summaries, research reviews and methodology pages across the site.

Open evidence summaries Open research reviews

Evidence summaries

Topic-led summaries for common MSK conditions, injection therapy, hyaluronic acid, Arthrosamid, shockwave and ultrasound-guided practice.

Browse evidence summaries

Research reviews

Longer-form pages designed to explain what the current literature means in practice for assessment, rehabilitation and injection decision-making.

Browse research reviews

What is in the library?

This library is designed to make the site’s evidence content easier to access from patient-facing and authority pages. It brings together the clinician hub evidence summaries, the longer research pages, and the methodology/governance pages that explain how content is written and updated.

Core evidence areas

  • Shoulder pain, rotator cuff tendinopathy and frozen shoulder evidence
  • Knee osteoarthritis, patellofemoral pain and injection evidence
  • Hip and gluteal tendinopathy evidence
  • Plantar heel pain and Achilles tendinopathy evidence
  • Ultrasound-guided injection accuracy and clinical reasoning
  • Hyaluronic acid, Arthrosamid and shockwave evidence pages

Best places to start

Ultrasound guidance evidence Injection therapy evidence Knee osteoarthritis evidence Frozen shoulder evidence Ultrasound-guided injection research review HA vs steroid injections review

Editorial standards

These pages are intended to translate the literature into practical, clinically useful guidance. They do not replace individual assessment. The site’s methodology and governance pages explain how evidence is interpreted and how page updates are handled.

Shoulder and injection research — BMJ reference collection

The following 43 citations are transcribed and abbreviated from a BMJ article's reference list supplied by the clinic (references 1–43). They are historical supporting literature, not 43 newly validated studies. Some may already appear elsewhere in our evidence library. This list includes studies on exercise, corticosteroid injections, ultrasound guidance, outcome measures and other interventions; their inclusion does not mean every study supports injections. Original articles and current guidelines should be considered when making clinical decisions.

  1. Van der Windt DA et al. (1995). Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis.
  2. Vecchio P et al. (1995). Shoulder pain in a community-based rheumatology clinic. Br J Rheumatol.
  3. Brox JI (2003). Regional musculoskeletal conditions: shoulder pain. Best Pract Res Clin Rheumatol.
  4. Khan KM (1999). Histopathology of common tendinopathies: update and implications for clinical management. Sports Med.
  5. Blaine TA et al. (2005). The molecular pathophysiology of subacromial bursitis in rotator cuff disease. J Shoulder Elbow Surg.
  6. Vangsness CT Jr et al. (1995). Neural anatomy of the glenohumeral ligaments, labrum, and subacromial bursa. Arthroscopy.
  7. Brox JI et al. (1993). Arthroscopic surgery compared with supervised exercises in patients with rotator cuff disease. BMJ.
  8. Haahr JP et al. (2005). Exercises versus arthroscopic decompression in patients with subacromial impingement. Ann Rheum Dis.
  9. Arroll B and Goodyear-Smith F (2005). Corticosteroid injections for painful shoulder: a meta-analysis. Br J Gen Pract.
  10. Buchbinder R et al. (2003). Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev.
  11. Koester MC et al. (2007). The efficacy of subacromial corticosteroid injection in the treatment of rotator cuff disease: a systematic review. J Am Acad Orthop Surg.
  12. Neustadt DH (1991). Local corticosteroid injection therapy in soft tissue rheumatic conditions of the hand and wrist. Arthritis Rheum.
  13. Gruson KI et al. (2008). Subacromial corticosteroid injections. J Shoulder Elbow Surg.
  14. Hollingworth GR et al. (1983). Comparison of injection techniques for shoulder pain: results of a double blind, randomised study. BMJ.
  15. Henkus HE et al. (2006). The accuracy of subacromial injections: a prospective randomized magnetic resonance imaging study. Arthroscopy.
  16. Valtonen EJ (1978). Double acting betamethasone in the treatment of supraspinatus tendinitis. J Int Med Res.
  17. Chen MJ et al. (2006). Ultrasound-guided shoulder injections in the treatment of subacromial bursitis. Am J Phys Med Rehabil.
  18. Naredo E et al. (2004). A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder. J Rheumatol.
  19. Hawkins RH and Kennedy JC (1980). Impingement syndrome in athletes. Am J Sports Med.
  20. Derogatis LR et al. (1974). The Hopkins symptom checklist (HSCL): a self-report symptom inventory. Behav Sci.
  21. Roach KE et al. (1991). Development of a shoulder pain and disability index. Arthritis Care Res.
  22. Kirkley A et al. (2003). Development and evaluation of the Western Ontario rotator cuff index. Clin J Sport Med.
  23. Brox JI et al. (1999). Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease: 2.5-year follow-up. J Shoulder Elbow Surg.
  24. Green S et al. (1998). Standardized protocol for measurement of shoulder range of movement using the Plurimeter-V inclinometer. Arthritis Care Res.
  25. Williams JW Jr et al. (1995). Measuring shoulder function with the shoulder pain and disability index. J Rheumatol.
  26. Schmitt JS and Di Fabio RP (2004). Reliable change and minimum important difference proportions. J Clin Epidemiol.
  27. Frison L and Pocock SJ (1992). Repeated measures in clinical trials: analysis using mean summary statistics. Stat Med.
  28. Vickers AJ (2005). Parametric versus non-parametric statistics in the analysis of randomized trials. BMC Med Res Methodol.
  29. Lirette R et al. (1992). The difficulties in assessment of results of anterior acromioplasty. Clin Orthop Relat Res.
  30. Romeo AA et al. (1996). Scoring systems for shoulder conditions. Am J Sports Med.
  31. Paul A et al. (2004). A comparison of four shoulder-specific questionnaires in primary care. Ann Rheum Dis.
  32. Razmjou H et al. (2006). Construct validity of two rotator cuff disease-specific outcome measures. BMC Musculoskelet Disord.
  33. Alvarez CM et al. (2005). Subacromial betamethasone and xylocaine versus xylocaine alone in chronic rotator cuff tendinosis. Am J Sports Med.
  34. Carette S et al. (2003). Intraarticular corticosteroids, supervised physiotherapy, or a combination for adhesive capsulitis. Arthritis Rheum.
  35. Guerra de Hoyos JA et al. (2004). Long-term effect of acupuncture for shoulder pain: randomised trial. Pain.
  36. Speed CA et al. (2002). Extracorporeal shock-wave therapy for tendonitis of the rotator cuff. J Bone Joint Surg Br.
  37. Bartolozzi A et al. (1994). Determinants of outcome in the treatment of rotator cuff disease. Clin Orthop Relat Res.
  38. Croft P et al. (1996). The clinical course of shoulder pain: prospective cohort study in primary care. BMJ.
  39. Park HB et al. (2005). Diagnostic accuracy of clinical tests for different degrees of subacromial impingement syndrome. J Bone Joint Surg.
  40. Speed CA (2007). Injection therapies for soft-tissue lesions. Best Pract Res Clin Rheumatol.
  41. Bisset L et al. (2006). Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow. BMJ.
  42. Hay EM et al. (2003). Local corticosteroid injection and physiotherapy for new episodes of unilateral shoulder pain. Ann Rheum Dis.
  43. Ginn KA et al. (1997). A randomized controlled clinical trial of a treatment for shoulder pain. Phys Ther.

Acromioclavicular joint injection and shoulder accuracy research

References transcribed from the supplied journal bibliography (historical studies; not all address ultrasound guidance directly). Bibliographic entries should be checked against journal records before being described as independently verified.

  1. Wasserman BR, Pettrone S, Rokito AS et al. (2012). Accuracy of acromioclavicular joint injections DOI
  2. Bigliani LU, Nicholson GP, Flatow EL (1993). Arthroscopic resection of the distal clavicle. Orthop Clin North Am. 1993;24:133–141
  3. Bisbinas I, Belthur M, Said HG, Green M, Learmonth DJ (2006). Accuracy of needle placement in ACJ injections. Knee Surg Sports Traumatol Arthrosc. 2006;14:762–765
  4. Butters KP, Rockwood CA Jr (1988). Office evaluation and management of the shoulder impingement syndrome. Orthop Clin North Am. 1988;19:755–765
  5. Eustace JA, Brophy DP, Gibney RP, Bresnihan B, FitzGerald O (1997). Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms. Ann Rheum Dis. 1997;56:59–63
  6. Flatow EL, Duralde XA, Nicholson GP, Pollock RG, Bigliani LU (1995). Arthroscopic resection of the distal clavicle with a superior approach. J Shoulder Elbow Surg. 1995;4:41–50
  7. Gerber C, Galantay RV, Hersche O (1998). The pattern of pain produced by irritation of the acromioclavicular joint and the subacromial space. J Shoulder Elbow Surg. 1998;7:352–355
  8. Hanchard N, Shanahan D, Howe T, Thompson J, Goodchild L (2006). Accuracy and dispersal of subacromial and glenohumeral injections in cadavers. J Rheumatol. 2006;33:1143–1146
  9. Jacob AK, Sallay PI (1997). Therapeutic efficacy of corticosteroid injections in the acromioclavicular joint. Biomed Sci Instrum. 1997;34:380–385
  10. Neer C (1990). Shoulder Reconstruction. Philadelphia: WB Saunders; 1990
  11. Partington PF, Broome GH (1998). Diagnostic injection around the shoulder: hit and miss? A cadaveric study of injection accuracy. J Shoulder Elbow Surg. 1998;7:147–150
  12. Pichler W, Weinberg AM, Grechenig S, Tesch NP, Heidari N, Grechenig W (2009). Intra-articular injection of the acromioclavicular joint. J Bone Joint Surg Br. 2009;91:1638–1640
  13. Sethi PM, Kingston S, Elattrache N (2005). Accuracy of anterior intra-articular injection of the glenohumeral joint. Arthroscopy. 2005;21:77–80
  14. Shaffer BS (1997). Painful conditions of the acromioclavicular joint. J Am Acad Orthop Surg. 1997;7:176–188
  15. Walton J, Mahajan S, Paxinos A et al. (2004). Diagnostic values of tests for acromioclavicular joint pain. J Bone Joint Surg Am. 2004;86:807–812
  16. Worcester JN Jr, Green DP (1968). Osteoarthritis of the acromioclavicular joint. Clin Orthop Relat Res. 1968;58:69–73
  17. Yamakado K (2002). The targeting accuracy of subacromial injection to the shoulder: an arthrographic evaluation. Arthroscopy. 2002;18:887–891

Further AC joint injection and image-guidance research (October 2026)

Evidence on injection accuracy should be interpreted separately from evidence of longer-term pain relief and function.

  1. Javed, S., Sadozai, Z. and Schmitgen, G. et al. (2017) Should all acromioclavicular joint injections be performed under image guidance? Journal of Orthopaedic Surgery. https://doi.org/10.1177/2309499017731633
  2. Menge, T.J., Boykin, R.E., Bushnell, B.D. et al. (2014) Acromioclavicular osteoarthritis: a common cause of shoulder pain. Southern Medical Journal, 107(5), pp.324–329.
  3. Mall, N.A., Foley, E., Chalmers, P.N. et al. (2013) Degenerative joint disease of the acromioclavicular joint: a review. American Journal of Sports Medicine, 41(11), pp.2684–2692.
  4. Tallia, A. and Cardone, D. (2003) Diagnostic and therapeutic injection of the shoulder region. American Family Physician, 67, pp.1271–1278.
  5. Peck, E., Lai, J.K., Pawlina, W. et al. (2010) Accuracy of ultrasound-guided versus palpation-guided acromioclavicular joint injections: a cadaveric study. PM&R, 2(9), pp.817–821.
  6. Stine, I.A. and Vangsness, C.T. (2009) Analysis of the capsule and ligament insertions about the acromioclavicular joint: a cadaveric study. Arthroscopy, 25, pp.968–974.
  7. Bain, G.I., van Riet, R.P., Gooi, C. et al. (2007) The long-term efficacy of corticosteroid injection into the acromioclavicular joint using a dynamic fluoroscopic method. International Journal of Shoulder Surgery, 1, pp.104–107.
  8. Sabeti-Aschraf, M., Lemmerhofer, B., Lang, S. et al. (2011) Ultrasound guidance improves the accuracy of the acromioclavicular joint infiltration: a prospective randomized study. Knee Surgery, Sports Traumatology, Arthroscopy, 19, pp.292–299.

Glenohumeral and shoulder injection research: 15 additional references

Additional frozen shoulder and glenohumeral injection research

The 2016 randomised study evaluated a hanging, internally rotated arm position as an alternative during posterior ultrasound-guided glenohumeral steroid injection in 42 people with adhesive capsulitis. It addresses procedural feasibility and positioning; it does not establish that this position is clinically superior for all patients. Other studies examine hydrodilatation, corticosteroid injections and injection placement. These studies vary in design and should not be interpreted as proof of superior long-term outcomes from ultrasound guidance.

  1. Lee, C.H., Nam, H.S. and Lee, S.U. (2016) “Usefulness of a hanging position with internal rotation of shoulder in ultrasonography-guided intra-articular steroid injection for adhesive capsulitis”, Annals of Rehabilitation Medicine, 40(3), pp. 520–527. Research source
  2. Shah, N. and Lewis, M. (2007) “Shoulder adhesive capsulitis: systematic review of randomised trials using multiple corticosteroid injections”, British Journal of General Practice, 57, pp. 662–667. Research source
  3. Park, K.D. et al. (2012) “Comparison of sono-guided capsular distension with fluoroscopically guided capsular distension in adhesive capsulitis of shoulder”, Annals of Rehabilitation Medicine, 36, pp. 88–97. Research source
  4. Tveitå, E.K. et al. (2008) “Hydrodilatation, corticosteroids and adhesive capsulitis: a randomized controlled trial”, BMC Musculoskeletal Disorders, 9, article 53. Research source
  5. Arslan, S. and Çeliker, R. (2001) “Comparison of the efficacy of local corticosteroid injection and physical therapy for the treatment of adhesive capsulitis”, Rheumatology International, 21, pp. 20–23. Research source
  6. Tobola, A. et al. (2011) “Accuracy of glenohumeral joint injections: comparing approach and experience of provider”, Journal of Shoulder and Elbow Surgery, 20, pp. 1147–1154. Research source
  7. Zwar, R.B., Read, J.W. and Noakes, J.B. (2004) “Sonographically guided glenohumeral joint injection”, AJR American Journal of Roentgenology, 183, pp. 48–50. Research source