Accuracy of Two Ultrasound‐Guided Coracohumeral Ligament Injection Approaches: A Cadaveric Study

Abstract

Background Glenohumeral idiopathic adhesive capsulitis is a common shoulder condition that hinders functionality. Addressing the pathology has been extensively researched. Ultrasound (US)‐guided injections have shown their efficacy. However, no study has been conducted to compare anatomical accuracy between different approaches in targeting the coracohumeral ligament (CHL). Objective To investigate whether US‐guided injection of the CHL can be performed accurately using either the rotator interval (RI) or the coracoidal (CO) approach. Methods An experimental cadaveric case series. Setting Anatomy laboratory. Specimens Both shoulders of 13 Thiel‐embalmed cadavers. Interventions Three physiatrists each injected a 0.1 mL bolus of colored dye in both shoulders of each cadaver using either the RI or the CO approach under US guidance. Each cadaver received a total of six injections (three injections per shoulder). The accuracy of the injection was determined following shoulder dissection by an anatomist. Main Outcome Measure The accuracy of the US‐guided injection of the CHL. Results The RI approach yielded 36 accurate injections, giving it an accuracy of 100%. With the CO approach two injections were deemed inaccurate yielding an accuracy of 94%. There was no significant difference in accuracy between all operators. Conclusions US‐guided injection of the CHL can be performed accurately with both the RI and CO approaches. The RI approach was likely to be more accurate.

Review of ultrasound-guided labeling: exploring its potential in teaching cadaveric ligaments during anatomical dissection courses

“…Here for instance, the coracoclavicular ligament, as with many other ligaments, has not yet been sonographically investigated on cadavers despite its clinical significance in the Rockwood classification of acromioclavicular joint injuries. In contrast, the coracohumeral ligament has been studied several times, including its identification via ultrasound, 43 injection approaches 31,44 and US-guided percutaneous sectioning technique. 45…”

“…Indeed, even small quantities (0.1 mL or a few drops) are adequate to correctly designate a ligament. 30 , 31 A further advantage is that needles can be reused or multiple ligaments from different body donors can be marked with the same needle, since disinfection plays only a minor role in body donations. Taking this idea even further, different elusive anatomical structures could be marked in different colors, which might assist the student to comprehend them more effectively and memorize the structure.…”

Ultrasound‐Guided Hydrodilatation of the Shoulder Capsule at the Rotator Interval: Technical Tips and Tricks

“…in cases of subacromial impingement) 4 and of the soft tissues encapsulating the LHBT in the rotator interval (eg, in cases of AC) 2 . The anatomical interface between the coracohumeral ligament and the LHBT (ie, the capsulo‐synovial cavity of the glenohumeral joint) is commonly referred to as the specific target zone for the infiltration 5 . Owing to the paramount role of this intervention in the management of a painful shoulder, we would like to focus on some anatomical details of the rotator interval architecture to propose a few useful tips and tricks in planning the previously quoted procedure.…”

Letter to the Editor Regarding “Ultrasound Features of Adhesive Capsulitis”

“…6 is at the level of the bicipital groove, with the greater and lesser tuberosities well visible, and not at the more proximal biceps pulley, also known as biceps sling. An ultrasound scanning technique for the coracohumeral ligament at the rotator interval has previously been described [ 3 ]. To our knowledge, no description of the coracohumeral ligament or the superior glenohumeral ligament within the bicipital groove has been made so far, despite numerous cadaveric [ 4 , 5 ] and imaging studies [ 6 – 8 ].…”