Accuracy of intra-articular glenohumeral injections: The anterosuperior technique with arthroscopic documentation

Purpose: Our objective was to assess the accuracy rate of needle placement with the anterosuperior technique of glenohumeral joint injection that uses familiar palpable superficial landmarks as a guide instead of diagnostic imaging. Methods: Between April 2007 and October 2007 at our institution, 42 patients met the study inclusion criteria of being aged 18 years or older and undergoing shoulder arthroscopy. For the injection (performed by 1 surgeon), anesthetized patients were placed in the beach-chair position with the arm in adduction and internal rotation. The surgeon was allowed to redirect the needle only once without withdrawing the needle from the entry site. After injection, arthroscopic confirmation of needle position in the joint and the presence of backflow from the posterior portal cannula were used to determine accuracy and the relation of the needle to adjacent anatomy. Results: Of the 42 injections, 38 needles were inserted accurately into the glenohumeral joint (91% accuracy rate), most through the rotator interval (21) or the long head of the biceps tendon (9). Four needles were placed inaccurately into the anterior synovium and subacromial space. Adhesive capsulitis was the diagnosis in 3 of those 4 shoulders but in only 5 of the 38 shoulders in the group with accurate placement (P < .05). Body mass index was not statistically different between the accurate and inaccurate injection groups (P > .05). Conclusions: Anterosuperior glenohumeral joint injection without image guidance provides an accuracy rate of 91%. The anterosuperior technique for glenohumeral injections yields an accuracy rate higher than that of the standard anterior techniques and comparable to that of posterior injection. Level of Evidence Level IV, diagnostic study.