A New Technique for Needle Aspiration and Injection of the Shoulder

Jan. 13, 2010 - PRLog -- While many techniques have been described to approach the glenohumeral joint anteriorly, there remains paucity in the techniques based on set anatomic landmarks. Variables like size and positioning can result in non-entry into the actual joint space, hence a “dry tap” or dispersion of steroid injection around the true joint space rather than in the joint itself.
We describe herein a cadaver based study using fluoroscopy guided by set anatomic landmarks, the first of its kind to our knowledge that showed a high rate of successful glenohumeral joint entry.  

Methods:
 Fresh cadaver specimens of the right and left upper extremities were used. A standard Fluoroscope was used during the injection/aspiration procedures. The landmarks and the technique were defined as follows:
On each side, the sternoclavicular joint was taken as the starting reference point with the tip of the acromion laterally as the end point and medial 1/3 rd from the tip of the acromion between the two marked as a landmark with a line drawn perpendicular extending from the clavicle downwards and below on the pectoralis major.  Another line drawn from the tip of the acromion laterally to the Xiphisternum was drawn and the intersection of the two lines was marked as the final point of entry. A spinal needle connected to a syringe was introduced at an angle of 40-45 degrees towards the glenohumeral joint till resistance felt from the head of the humerus. The needle was drawn back and at this point was found to be in the true joint space ready for aspiration or injection. The involved arm was allowed to hang down from the table to open up the joint space for easy and better entry.
Various physicians including orthopedic surgeons, rheumatologists, anesthesiologists and internists were asked to inject the joint using the technique that they generally used followed by our technique, both under fluoroscopic guidance. They were blinded to both techniques, each time respectively. Each physician performed on both sides at least once. A total of 15 physicians performed the procedure. (n=30).

Results:
The number of successful glenohumeral joint entries using our technique was significantly higher than conventional methods.  Using the new technique described herein, the success rate of entering the glenohumeral joint space based on fluoroscopy was 86.7% compared to 53.3% using conventional technique. Odds ratio=5.69, Chi square=7.94 and a p-value=0.0048)This was further confirmed by injecting a dye in the joint space aided by real time fluoroscopy imaging simultaneously while using the technique.

Conclusions:
This new technique for glenohumeral joint injection and aspiration has a significantly higher success rate compared to conventional methods and can be performed with ease irrespective of patient size. This study simulates the actual clinical scenario very closely since it was performed on fresh cadaver specimens and should help clinicians to inject or aspirate the joint with ease without the aid of ultrasound and or fluoroscopy.

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