Indirect ultrasound guidance increased accuracy of the glenohumeral injection using the superior approach: a cadaveric study of injection accuracy

Abstract

Objective: To investigate whether or not indirect ultrasound guidance could increase the accuracy of the glenohumeral joint injection using the superior approach.

Methods: Twelve shoulders from 7 adult cadavers were anatomically dissected after a dye injection had been performed, while the cadavers were in the supine position. Before the injection, a clinician determined the injection point using the ultrasound and the more internal axial arm rotation was compared to how it was positioned in a previous study. Injection confidence scores and injection accuracy scores were rated.

Results: The clinician's confidence score was high in 92% (11 of 12 shoulders) and the injection accuracy scores were 100% (12 of 12 shoulders). The long heads of the biceps tendons were not penetrated.

Conclusion: Indirect ultrasound guidance and positioning shoulder adducted at 10° and internally rotated at 60°-70° during the superior glenohumeral joint injection would be an effective method to avoid damage to the long head of biceps tendons and to produce a highly accurate injection.

Keywords: Cadaver; Injections; Shoulder; Superior; Ultrasound.

Fig. 1

The cadaver's hand is located on his/her abdomen. In this position, the elbow was flexed 90°, the shoulder was positioned at 10° of adduction and at 60°-70° of internal rotation. The arrow indicates the injection on point.

Fig. 2

In the transverse view of ultrasonography, the long head of biceps tendon (arrow) is seen in the bicipital groove level (A) and the more proximal level (B). The tendon adheres to the superior margin of the glenoid and is located beside the CO at the coracoid process level (C). GT, greater tubercle of humeral head; CO, coracoid process.

Fig. 3

Blue dye is seen in the glenohumeral joint cavity. The blue needle (A) was inserted through the anterolateral side of the acromioclavicular joint and is located on the lateral side of the long head of biceps brachii tendon (arrow). The yellow needle (B) is the landmark of the anterior acromioclavicular joint.