Learning objectives
Learning objective is to present the easiest access to the glenohumeral joint under the ultrasound guidance,
for Magnetic Resonance (MR) artrography which can be also used for steroide injections.
Background
MR arthrography still remains the gold standard in identifying labral lesions as on plain MR contrast resolution is scarse.
In the past contrast media were injected under the fluoroscopic guidance,
exposing patients and staff to the radiation.
Posterior approach under ultrasound guidance gives a safe and easy access to glenohumeral joint.
Imaging findings OR Procedure Details
Patient is positioned on the opposite flank (figure 2) with the hand holding the opposite shoulder.
Under ultrasound guidance 5 mL of Lidocain is injected mostly in thesubcutaneous tissue (figure 3 and 4).
After a minute (when patient loses the feeling on the puncture place) posterior recess of the glenohumeral (GH) joint is visualized.
Usually the probe is placed 15 mm medially and 15 mm caudally to theacromion.
Probe is placed in the tranverse plane (figure 5),
which worsens the visualization of the needle,
but...
Conclusion
Injection under the ultrasound guidance is an easy and quick way of reaching the glenohumeral joint,
without radiation exposure which can be used for MR arthrography and steroid injections.
As we use iodine contrast as a part of the mixture we can transfer patients on CT in case of panic attacks or previously unknown metal artifacts (figure 9).
We have presented technical details of procedure and severeal imagesof lesions found in series of 23 patients done at the Diagnostic and Interventional Radiology Department at the...
References
Rhee RB,
Chan KK,
Lieu JG,
Kim BS,
Steinbach LS.
MR and CT arthrography of the shoulder.Semin Musculoskelet Radiol.
2012;16:3-14.
Steinbach LS1,
Palmer WE,
Schweitzer ME.Special focus session.
MR arthrography.Radiographics.
2002;22:1223-46.