Are blind injections of gleno-humeral joint (GHJ) really less accurate imaging-guided injections? A narrative systematic review considering multiple anatomical approaches

Simoni, Paolo; Grumolato, Marco; Malaise, Olivier; Preziosi, Marco; Pasleau, Françoise; Esteves, Frédéric De Lemos

doi:10.1007/s11547-017-0772-4

Cited by 13 publications

(14 citation statements)

References 61 publications

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“…In agreement with former results, 7,27,28,33 in the current work blinded injection was more painful than the two image‐guided techniques but the difference was not significant during the procedure, yet was statistically significant 24 hours later. This could be attributed to the multiple blinded attempts to correctly enter the joint.…”

Section: Discussionsupporting

confidence: 92%

“…However, correct intra‐articular contrast injection is essential to the diagnostic efficacy of shoulder MRA; it may be a great challenge for nonexperienced radiologists 5,6 . Contrast extravasation due to incorrect needle placement may obscure pathological findings 7 . Previous studies have demonstrated that image‐guided approaches performed under fluoroscopy (FL), ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI)‐guidance are more effective than non‐image‐guided techniques 7,8 .…”

mentioning

confidence: 99%

“…Contrast extravasation due to incorrect needle placement may obscure pathological findings 7 . Previous studies have demonstrated that image‐guided approaches performed under fluoroscopy (FL), ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI)‐guidance are more effective than non‐image‐guided techniques 7,8 . The type of imaging guidance used for shoulder puncture depends on the operator experience and the equipment availability 9 .…”

mentioning

confidence: 99%

“…Non‐image‐guided shoulder injection is less time‐consuming, does not involve radiation exposure or require special equipment, but its accuracy remains a matter of debate; ranging from 26–100% 20‐22 . Bony landmarks such as the coracoid process or the sulcus between it and the humeral head may be difficult to palpate, especially in very muscular or obese patients, and it is not possible to ensure intra‐articular needle position nor adequate capsular distension until imaging has been acquired 7,8,20,21,23,24 …”

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confidence: 99%

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Shoulder MR Arthrography: Comparative Evaluation of Three Different Contrast Injection Techniques Using an Anterior Approach

Ali

Said

Elhamd

et al. 2020

Magnetic Resonance Imaging

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BackgroundMR arthrography (MRA) is commonly used in the assessment of shoulder internal derangements. Correct intra‐articular contrast injection is required for this modality. Anterior injections under fluoroscopic, ultrasound‐guidance, or without image‐guidance have been described in the literature. However, no simultaneous comparison has been performed between the three techniques.PurposeTo compare the accuracy and performance of fluoroscopy (FL)‐guided, ultrasound (US)‐guided and non‐image‐guided intra‐articular contrast injection via an anterior approach for performing shoulder MRA.Study TypeProspective.SubjectsTwo‐hundred and ten patients (180 men and 30 women; mean age, 33 ± 12 years; range 20–60 years) with clinically suspected shoulder pathology.Field Strength/Sequence1.5T/fat‐suppressed T1‐weighted, T2‐weighted, and 3D‐gradient‐echo images.AssessmentPatients underwent shoulder MRA after anterior intra‐articular contrast injection under FL‐ or US‐guidance or without image‐guidance. Patients were randomized among the three techniques with each group comprising 70. The techniques were compared according to the accuracy of intra‐articular needle placement, attempts success rate, pain during and 24 hours after injection, procedure times, contrast extravasation rate, joint distension, and MRA diagnostic efficacy. Pain was assessed by the visual analog scale (VAS) pain‐score.Statistical TestsPearson's chi‐squared and Kruskal–Wallis tests.ResultsFL‐ and US‐guided injections (100% accuracy) were significantly more accurate than non‐image‐guided (85.7% accuracy) (P < 0.05). US‐guidance was the least painful, with statistical differences between image‐guided and non‐image‐guided techniques regarding the first attempt success rate (95.7% and 92.8% for FL‐ and US‐guided vs. 78.6% for blinded), VAS‐score 24 hours‐post‐procedure (1.7 ± 1.7, and 1.5 ± 1.4 vs. 2.2 ± 1.4), procedure time (11.9 ± 1.6, and 7.4 ± 1.7 vs. 4.3 ± 0.76 minutes), and contrast extravasation rate (5.7%, and 8.6% vs. 30%) (all P < 0.05). Procedure time was also significantly different between FL and US‐guidance (P < 0.05).Data ConclusionImaging‐guided injections are more accurate and tolerable than non‐image‐guided and should be considered to confirm intra‐articular needle position, hence adequate capsular distension and good diagnostic quality of shoulder MRA. US guidance is a less painful, rapid, and safe alternative to the FL approach.Evidence Level: 2Technical Efficacy Stage: 5.J. MAGN. RESON. IMAGING 2021;53:481–490.

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Shoulder MR Arthrography: Comparative Evaluation of Three Different Contrast Injection Techniques Using an Anterior Approach

Ali

Said

Elhamd

et al. 2020

Magnetic Resonance Imaging

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“…Unguided glenohumeral injection techniques may offer an alternative to avoid such disadvantages; however, they may be less reliable with often lower accuracy rates compared with guided injection techniques 5 . To date, there is no established technique for an accurate and reproducible unguided glenohumeral injection, despite the benefits of an accurately targeted injection for patients with shoulder symptoms, such as improved responses to therapeutic medications and reduced injury to surrounding structures 6, 7.…”

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confidence: 99%

Transcoracoacromial Ligament Glenohumeral Injection Technique Using Bony Surface Landmarks

Shi

Sohn

Shao

et al. 2019

Arthroscopy Techniques

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Intra-articular glenohumeral injection is an important technique used to diagnose and treat shoulder disorders. However, it is frequently performed as an image-guided technique with the use of fluoroscopy, ultrasound, computed tomography, or magnetic resonance. The purpose of this Technical Note is to describe a transcoracoacromial ligament glenohumeral injection technique that uses anatomic surface landmarks to avoid the need for radiographic guidance. After identification of the anterolateral corner of acromion, the superior lateral border of the coracoid tip, and the curved depression of the distal clavicle, the needle entry site is determined at the trisection point between the distal and middle thirds of the line formed by the superior lateral border of the coracoid tip and the curved depression of the distal clavicle. The needle is first inserted perpendicular to the triangular plane of the 3 points and is then advanced toward the humeral head. This injection technique is highly accurate and reproducible and can be done in the outpatient clinic without the use of imaging guidance, reducing the costs and barriers of intra-articular glenohumeral injections for patients.

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Ultrasound-guided interventions of the upper extremity joints

et al. 2022

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Ultrasound guidance is valuable for performing precise joint interventions. Joint interventions may be requested for therapeutic and diagnostic pain injections, joint aspiration in the setting of suspected infection, or contrast injection for arthrography. In practice, interventions of the shoulder girdle, elbow, and hand/wrist joints may be performed without any imaging guidance. However, imaging guidance results in more accurate interventions and better patient outcomes than those performed by palpation alone. When compared to other modalities used for imaging guidance, ultrasound has many potential advantages. Radiologists should be prepared to perform ultrasound-guided upper extremity joint interventions utilizing recommended techniques to optimize clinical practice and patient outcomes. Key points 1. Ultrasound-guided injections of the glenohumeral, acromioclavicular, sternoclavicular, elbow, and hand/wrist joints have higher accuracy than injections performed without imaging guidance. 2. Ultrasound-guided aspirations of upper extremity joints have advantages to fluoroscopic-guided aspirations because of the potential to identify effusions, soft tissue abscess, or bursitis. 3. Ultrasound-guided contrast injection prior to MR arthrography is as accurate as fluoroscopic-guided injection for upper extremity joints.

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Are blind injections of gleno-humeral joint (GHJ) really less accurate imaging-guided injections? A narrative systematic review considering multiple anatomical approaches

Cited by 13 publications

References 61 publications

Shoulder MR Arthrography: Comparative Evaluation of Three Different Contrast Injection Techniques Using an Anterior Approach

Shoulder MR Arthrography: Comparative Evaluation of Three Different Contrast Injection Techniques Using an Anterior Approach

Transcoracoacromial Ligament Glenohumeral Injection Technique Using Bony Surface Landmarks

Ultrasound-guided interventions of the upper extremity joints

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