Hombro/Shoulder/Schulter/Èpaule: donde pones el ojo sueles poner la aguja

Accuracy of Palpation-Directed Intra-articular Glenohumeral Injection Confirmed by Magnetic Resonance Arthrography
Scott E Powell, Shane M Davis, Emily H Lee, Robert K Lee, Ryan M Sung, Claire McGroder, Shalen Kouk, Christopher S Lee
Arthroscopy: the Journal of Arthroscopic & related Surgery 2014 October 8 [Epub ahead of print]

PURPOSE: The aim of this study was to determine the accuracy of anatomic palpation-directed injections in the office setting.

METHODS: Two hundred twenty-six shoulders in 208 patients were studied using a 0.2-Tesla extremity scanner after the injection of gadolinium-diethylene triamine pentaacetic acid-saline. All patients were injected in a sterile fashion by a single board-certified shoulder surgeon using an anterior approach by palpating the rotator interval anterior to the acromioclavicular joint and angling the needle 45° lateral and 45° caudad. All injections, successful or otherwise, were single injections. Magnetic resonance (MR) arthrograms were retrospectively read by 2 musculoskeletal fellowship-trained, board certified radiologists to determine whether the injection was in the glenohumeral joint.

RESULTS: Two hundred one of the 226 injections were successful (88.9%). Of the 25 unsuccessful injections, the contrast material extravasated out of the capsule in 5 cases and into the subscapularis tendon in 10 cases. The contrast material was injected into the subacromial space in 9 cases, into the rotator interval fat in 9 cases, and into extracapsular tissue in 6 cases. There was insufficient volume of contrast material in 10 cases. The accuracy rate was 88.9%. There were no complications.

CONCLUSIONS: The palpation-directed rotator interval anterior approach technique for intra-articular glenohumeral MR arthrogram injections performed by a single surgeon was 88.9% accurate.

LEVEL OF EVIDENCE: Level IV, therapeutic case series.