Accuracy of intra-articular injections of the glenohumeral joint through an anterior approach: arthroscopic correlation

Abstract

Intra-articular injections of the glenohumeral joint are an important tool for orthopedic surgeons who treat the spectrum of shoulder disorders. Previous studies, however, have suggested that these injections may not be reliably placed intra-articularly in the glenohumeral joint when performed in the office setting and that radiographic assistance may be necessary. This study assessed the accuracy of a glenohumeral injection through an anterior approach with arthroscopic confirmation. The study included 75 consecutive patients who were undergoing routine shoulder arthroscopy for a variety of shoulder disorders. All underwent anterior placement of a 1.5-inch, 21-gauge needle using a location just lateral to the coracoid and angled 45° toward the glenohumeral joint. After injection of sterile saline, a diagnostic arthroscopy was initiated through a standard posterior portal. The needle was considered intra-articular if fluid was expressed from the eyelet of the needle when the arthroscopy pump was turned on or with direct visualization of the needle with the arthroscope, or both. The needle was visualized with the arthroscope in all 75 patients (100%). In 70 patients (93.3%), fluid was expressed through the eyelet of the needle when the arthroscopy pump was turned on. The results of this study show that an anterior injection into the glenohumeral joint can be accurately placed without radiographic assistance using standard landmarks. The technique used is similar to making a standard rotator interval portal during shoulder arthroscopy; therefore, it is most successful in the hands of experienced shoulder arthroscopists.