Glenohumeral joint injection: a comparative study of ultrasound and fluoroscopically guided techniques before MR arthrography

Abstract

To assess the variability in accuracy of contrast media introduction, leakage, required time and patient discomfort in four different centres, each using a different image-guided glenohumeral injection technique. Each centre included 25 consecutive patients. The ultrasound-guided anterior (USa) and posterior approach (USp), fluoroscopic-guided anterior (FLa) and posterior (FLp) approach were used. Number of injection attempts, effect of contrast leakage on diagnostic quality, and total room, radiologist and procedure times were measured. Pain was documented with a visual analogue scale (VAS) pain score. Access to the joint was achieved in all patients. A successful first attempt significantly occurred more often with US (94%) than with fluoroscopic guidance (72%). Leakage of contrast medium did not cause interpretative difficulties. With US guidance mean room, procedure and radiologist times were significantly shorter (p < 0.001). The USa approach was rated with the lowest pre- and post-injection VAS scores. The four image-guided injection techniques are successful in injection of contrast material into the glenohumeral joint. US-guided injections and especially the anterior approach are significantly less time consuming, more successful on the first attempt, cause less patient discomfort and obviate the need for radiation and iodine contrast.

Should we continue to administer blind shoulder injections?

“…Furthermore, no difference was detected at first entry in fluoroscopic injection Many studies indicate that superior and earlier improvement in shoulder pain and increased range of motion in the shoulder joint are possible with US-guided injections compared to blind injections. [2,5,14] In our study, clinically improved pain was observed in all patients except one. Decrease in VAS scores continued for one month.…”

“…[13] In another study, Ucuncu et al [5] compared US with landmark-guided injection in a randomized study and demonstrated significantly improved pain intensity in US group compared with blind group six weeks after injection (mean VAS score decrease: 4.0±1.7 for US vs. 2.2±0.9 for blind). Rutten et al [14] compared FL with US-guided intra-articular shoulder injections and reported 76% accuracy in FL and 96% in US on the first attempt using an anterior approach.…”

A physiotherapy perspective of musculoskeletal imaging in sport

“…This is now a relevant issue for physiotherapists as many working in an extended scope role in the NHS are now performing injections. It has been documented that 14-71% of injections carried out ''blind''-without image guidance-miss their target [23][24][25][26][27]. What we do not know is whether this makes a difference in clinical efficacy.…”

Ultrasonography and Ultrasound-guided Interventions of the Shoulder

“…Altogether these findings reflect the importance of a imaging-guided method for glenohumeral joint injections. 35,36) Gokalp et al 37) reported that injections from the posterior side of the patient is more favorable than from the anterior side where important structural elements such as the glenohumeral ligament may get in the way. Agreeing with Gokalp et al's findings, 37) authors too made the injection from the posterior side of the patient.…”