MR Arthrography of the Shoulder

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

“…Intra-articular deposition of contrast material was successful in all patients, which is comparable with reported results in the literature [2, 3, 10, 13]. The success rate of the first attempt with US guidance (97%) was significantly better compared to fluoroscopic guidance (72%).…”

“…The Flp injections are performed in prone position with the symptomatic shoulder slightly raised until the glenohumeral joint is seen tangentially [9, 10]. The injection site is infiltrated with local anaesthetic [prilocaïnehydrochloride 10 mg/ml (Citanest® 1%), Astra Pharmaceutica, Zoetermeer, The Netherlands] using a 0.8 × 50-mm bevelled needle (21 gauge).…”

“…With the shoulder in a neutral position or slightly internally rotated, the needle is aimed at the inferomedial quadrant of the humeral head and advanced vertically under fluoroscopic guidance to the cartilage of the humeral head (Figs. 2 and 4) [9, 10].

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“…According to the numerous publications on this subject, it is still an item of investigation [2–20]. There are various techniques from blind [4,17,19] to image guided [2,3,10,12]. Glenohumeral injections are generally performed using an anterior approach under fluoroscopic guidance, which was first described in 1933 by Oberholzer [21] and modified by Schneider [22].…”

“…Glenohumeral injections are generally performed using an anterior approach under fluoroscopic guidance, which was first described in 1933 by Oberholzer [21] and modified by Schneider [22]. Other methods for intra-articular injection of the glenohumeral joint have been described, e.g., fluoroscopically guided using a posterior approach [9, 10], palpation directed [4, 19], ultrasound (US) [2, 3, 14], CT [11] and MR guided [7, 20]. These studies deal mostly with the techniques and/or their feasibility.…”