Intraarticular Shoulder Injection—Posterior Approach: Ultrasound Guidance

Abstract

Using ultrasound, the glenohumeral (GH) joint can be accessed from either an anterior or posterior approach. The posterior approach, medial to lateral, described in this chapter, can prevent injury to the labrum. There is also a posterior, lateral to medial approach, which is also demonstrated ( Fig. 34B.3E ) but not fully described. Fluoroscopic visualization after needle placement and contrast injection can be confirmatory.

keywords

Frozen Shoulder, Glenohumeral joint, Shoulder joint, Ultrasound

Note: Please see pages ii , iii for a list of anatomic terms/abbreviations used throughout this book.

Using ultrasound, the glenohumeral (GH) joint can be accessed from either an anterior or posterior approach. The posterior approach, medial to lateral, described in this chapter, can prevent injury to the labrum. We also demonstrate an alternate posterior, lateral to medial approach with limited figures ( Fig. 34B.4 ). Fluoroscopic visualization after needle placement and contrast injection can be confirmatory.

In-Plane Technique ( Fig. 34B.1 )

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Patient is positioned side-lying on contralateral shoulder.

Fig. 34B.1

A, Room, interventionalist, transducer, and US unit setup for USG intraarticular shoulder injection. B, Ultrasound image of intraarticular glenohumeral joint needle placement adjacent to the labrum. C, Drawing of relevant structures. Needle is green; blue indicates the joint capsule, cartilage, and space. D, Skeleton showing proper placement of ultrasound transducer and needle.
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Patient’s ipsilateral arm should be internally rotated and adducted across the chest to open the joint space.
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Interventionalist stands behind the patient ( Fig. 34B.1E ).
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Ultrasound image is in front of the patient on the opposite side of the interventionalist and in line with the transducer (see Fig. 34B.1A and Chapter 4 ).
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Begin by placing the transducer over the posterolateral shoulder parallel and just inferior to the scapular spine .
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Identify the humeral head, GH joint capsule, labrum, and bony glenoid with overlying infraspinatus and deltoid muscles ( Fig. 34B.1B,C ).
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Rotate the transducer to optimize simultaneous visualization of the above structures.
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Insert the needle from an inferomedial to a superolateral direction toward the joint capsule.
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While visualizing the needle tip in-plane, advance until it enters the capsule and lies adjacent to the labrum ( Fig. 34B.1B,C ).
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If resistance is encountered while administering the injectate, the needle may be embedded in cartilage, labrum, or within the capsule. Slightly withdrawing or advancing the needle while injecting will produce a loss of resistance and improved flow of injectate. Confirm the flow is subcapsular and intraarticular.