Shoulder Procedures
KEY FACTS
Preprocedure
- • Indication
Glenohumeral joint aspiration (suspected infection) or injection (contrast for arthrography; adhesive capsulitis symptom relief)
Subacromial-subdeltoid (SA-SD) bursal injection (symptom relief) or aspiration (suspected infection)
Calcific tendinitis (symptom relief)
Rotator cuff tendinosis or tear (symptom relief and to promote healing)
Acromioclavicular joint injection (symptomatic relief)
position for lateral long-axis approach to posterior glenohumeral joint for contrast injection before MR arthrography.
and labral avulsion 
. US-guided MR arthrography is a commonly performed procedure.
. The largest calcification 
, calcification with the most focal edema, or calcification that most closely correlates with symptoms are best targeted for percutaneous lavage and aspiration.
using an 18-g needle, connected to a syringe containing a saline-lignocaine mixture. Lavage and aspiration are performed in series.PREPROCEDURE
Indications
PROCEDURE
Procedure Steps
- • General preparation of all percutaneous intervention
- • Glenohumeral j oint injection or aspiration
General practical points irrespective of anterior (rotator cuff interval) or posterior approach
- – Use free-hand technique to advance needle into joint space under real-time imaging
- – Can use long-axis or short-axis approaches
- – Ensure needle tip is within joint space
- – Avoid injection of bubbles by first flushing syringe and tubing with injectate
- – Free flow of fluid with low-pressure injection and minimal patient discomfort helps confirm intraarticular position of needle tip
- – Avoid active exercise to prevent leakage of solution along needle track for 20 minutes
Posterior approach
- – Various positions can be used
- – In longitudinal plane, identify posterior glenohumeral joint, glenoid, labrum, and humeral head deep to infraspinatus musculotendinous junction
- – Either short-axis (preferable) or long-axis needle approach can be used
- – Short-axis approach allows joint to be approached more vertically than with long-axis approach
- – Long axis is preferable as needle path easier to see
- – “Pop” felt when needle transverses joint capsule
Rotator interval approach
- • Arthrography
10-20 mL of contrast solution is injected until joint capsule is satisfactorily distended
Volume of injection is determined according to patient’s comfort level and resistance to injection
Patients with severe adhesive capsulitis will feel distension after only small volume (5-10 mL) of fluid injected into joint
Patients following shoulder dislocation can accommodate larger volumes (15-20 mL)
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