Shoulder/Acromioclavicular Joint Injection—Out-of-Plane Approach: Ultrasound Guidance

Abstract

There are several approaches to inject the acromioclavicular joint (ACJ). The out-of-plane technique, anterior to posterior, short axis to the joint, described in this chapter is an effective approach to deliver a therapeutic agent into the intraarticular space while avoiding nearby structures including the acromioclavicular and coracoclavicular ligaments. The joint can also be approached in plane either lateral to medial (demonstrated but not described) or anterior to posterior. A hypoechoic fluid collection, known as the geyser sign, can indicate joint pathology and can further help visualize accurate needle placement.

Keywords

Acromioclavicular joint, Shoulder joint, Ultrasound

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

There are several approaches to inject the acromioclavicular joint (ACJ). The out-of-plane technique, anterior to posterior, short axis to the joint, described in this chapter is an effective approach to deliver a therapeutic agent into the intraarticular space while avoiding nearby structures including the acromioclavicular and coracoclavicular ligaments. The joint can also be approached in-plane either lateral to medial (demonstrated in Fig. 34D.4 but not described) or anterior to posterior. A hypoechoic fluid collection, known as the geyser sign, can indicate joint pathology and can further help visualize accurate needle placement.