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

Ann Rehabil Med. 2013 Apr;37(2):202-7. doi: 10.5535/arm.2013.37.2.202. Epub 2013 Apr 30.

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.