Glenohumeral joint penetration with a 21-gauge standard needle

Tong, Aureola; Harding, Richard; Graham, Geoff

doi:10.1016/j.jse.2011.11.034

Cited by 4 publications

(3 citation statements)

References 11 publications

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“…[7,8] Injections are recommended via the anterior, posterior or supraclavicular approach. [9] Tong et al [10] investigated anterior and posterior approach to penetrate the glenohumeral joint with a standard 21-gauge needle. They showed that the mean joint depth was 43.5 mm at posterior and 27.1 mm at anterior side.…”

Section: Discussionmentioning

confidence: 99%

Should we continue to administer blind shoulder injections?

Ağırman

Leblebicier

Durmuş

et al. 2016

Eklem Hastalik Cerrahisi

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ÖZAmaç: Bu çalışmada omuz ağrısı olan hastalarda kör ve floroskopi rehberli eklem içi omuz enjeksiyonlarının doğruluğu ve etkinliği araştırıldı. Hastalar ve yöntemler: Çalışmaya üç aydan uzun süredir omuz ağrısı olan 17 hasta (6 erkek, 11 kadın; ort. yaş 52.6±9.9 yıl; dağılım 36-66 yıl) dahil edildi. İlk eklem içi enjeksiyonlar ön yaklaşım ile kör olarak uygulandı. Enjeksiyon sonrası iğne ucunun eklem içerisinde olduğu floroskopi ve kontrast dağılımı ile doğrulandıktan sonra işlem 3 mL lokal anestezik (prilokain ve bupivakain) ve 1 mL steroid (40 mg metilprednizolon) ile tamamlandı. İlk uygulamada kontrast dağılımının eklem dışı olduğu gözlendiğinde, ikinci enjeksiyona floroskopi eşliğinde devam edildi. İşlemin devam ettirilmesi ile tüm enjeksiyonlar eklem içi oldu. Ağrı yoğunluğu görsel analog ölçeği (GAÖ) ile ölçüldü. Bulgular: Floroskopi ile bakılan kontrast dağılımına göre, 17 omzun 11'inde (%64.7) birinci kör enjeksiyonlar eklem içi idi. Başlangıç GAÖ skoru ortalaması 7.11 idi. Klinik takiplerde birinci saatte (ortalama GAÖ: 2.35), üçüncü günde (ortalama GAÖ: 2.64) ve birinci ayın sonunda (ortalama GAÖ: 2.23) ağrıda iyileşme gözlendi. Kör ve floroskopi rehberli uygulama için hasta hazırlanma süresi dışındaki ortalama süre sırasıyla 0.8 dakika ve 4.2 dakika idi. Sonuç: Kör eklem içi omuz enjeksiyonları ucuz ve kolay uygulanabilir olsa da iğnenin eklem çevresinde değil eklem içinde olduğundan emin olmak için enjeksiyonlar floroskopi ya da başka bir rehber eşliğinde yapılmalıdır.Anahtar sözcükler: Enjeksiyon; eklem içi; ağrı; omuz. ABSTRACT Objectives:This study aims to investigate the accuracy and effectiveness of blind and fluoroscopic-guided intra-articular shoulder injections in patients with shoulder pain. Patients and methods: The study included 17 patients (6 males, 11 females; mean age 52.6±9.9 years; range 36 to 66 years) with shoulder pain more than three months. First intra-articular joint injections were performed with anterior approach blindly. Following the injection and after confirming that the needle tip was intra-articular with fluoroscopy and contrast distribution, the procedure was completed using 3 mL of local anesthetic (prilocaine and bupivacaine) and 1 mL of steroid (40 mg methylprednisolone). When the contrast distribution was observed to be extra-articular at the first administration, a second injection was continued under fluoroscopy guidance. All of the injections were intraarticular with the continuation of the procedure. Pain intensity was measured with visual analog scale (VAS). Results: According to the contrast distribution viewed with fluoroscopy, first blind injections were intra-articular in 11 of the 17 shoulders (64.7%). Mean of initial VAS score was 7.11. Improved pain was observed in the clinical follow-ups at the first hour (mean VAS: 2.35), third day (mean VAS: 2.64), and at the end of the first month (mean VAS: 2.23). The mean durations for blind and fluoroscopic-guided procedures excluding patients' preparation time were 0.8 minutes and 4.2 minutes, respectively. Con...

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Section: Discussionmentioning

confidence: 99%

Should we continue to administer blind shoulder injections?

Ağırman

Leblebicier

Durmuş

et al. 2016

Eklem Hastalik Cerrahisi

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“…To date, the needle length required to achieve intra‐articular fluoroscopic guided injection of the hip, knee, and glenohumeral joints based on patient clinical characteristics remains unknown. Tong et al showed that the distance from the skin to the glenohumeral joint was shorter using an anterior approach compared to the posterior approach; however, they did not create any nomogram that could be reliably used when estimating the optimal needle length required 23 . A prior study by Teske et al hypothesized that at least a 2‐inch needle is needed to achieve a glenohumeral joint injection using the Neviaser approach, which is not commonly used in practice 24 .…”

Section: Introductionmentioning

confidence: 99%

“…Tong et al showed that the distance from the skin to the glenohumeral joint was shorter using an anterior approach compared to the posterior approach; however, they did not create any nomogram that could be reliably used when estimating the optimal needle length required. 23 A prior study by Teske et al hypothesized that at least a 2-inch needle is needed to achieve a glenohumeral joint injection using the Neviaser approach, which is not commonly used in practice. 24 Teske et al also noted that longer needle lengths may be required for patients with higher body mass index (BMI) and may depend on the patient's habitus.…”

Section: Introductionmentioning

confidence: 99%

Statistically based nomograms for the minimal needle length required to achieve intra‐articular fluoroscopic‐guided injections of the shoulder, hip, and knee

Sebro

Garza-Ramos

2022

PM&R

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Background: Image-guided intra-articular injections are commonly performed to reduce pain in patients with arthritis or other joint-related pathology. Utilizing a needle length that is too short could lead to increased patient discomfort, increased procedural time, and extra-articular injections. Objective: To predict the minimum needle length required for fluoroscopicguided intra-articular injections of the hips, knees, and shoulders based on patient age, gender, height and weight, or body mass index (BMI) and to evaluate whether this varies by gender. Study Design: Cross-sectional study. Setting: Tertiary care academic center. Participants: 600 consecutive patients with available magnetic resonance imaging (MRI) of the hips, knees, and shoulders (100 males and 100 females for each joint). Methods: The distance from the skin to the joint (glenohumeral, hip and knee) and the thickness of the subcutaneous fat pad (distance from the skin to the muscle) along the injection path were measured. Multivariable linear ridge regression with 10-fold cross-validation was used to predict the distance from the skin to the hip, knee, and glenohumeral joints using age, gender, weight, and height or using age, gender, and BMI. Results: The data show that the subcutaneous fat thickness and the distance from the skin to all joints increase with weight (p < .001) and BMI (p < .001). Subcutaneous fat pads around the anterior shoulder (p < .02) and knee (<.001) are thicker in women than in men. Conclusions: Patient habitus, in particular weight and BMI, are strong predictors of the thickness of the subcutaneous fat pads and consequently strong predictors of the distance from the skin to the joint. Subcutaneous fat pad thickness around the shoulders and knees varies by gender. Nomograms showing the minimal needle length required to achieve intra-articular injections of the hip, knee and glenohumeral joints are presented.

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