High accuracy of intra-articular needle position during anterior landmark guided glenohumeral injections.

Objectives: Image-guided ultrasound or fluoroscopic glenohumeral injections have high accuracy rates but require training, equipment, cost, and radiation exposure (fluoroscopy). In contrast, landmark-guided glenohumeral injections do not require additional subspecialist referrals or equipment. An optimal technique would be safe and accurate and have few barriers to implementation. The purpose of this study was to define the accuracy of glenohumeral needle placement via an anterior landmark-guided approach as assessed by direct arthroscopic visualization.
Methods: A consecutive series of adult patients undergoing shoulder arthroscopy in the beach chair position were included in this study. Demographic and procedural data were collected. The time required to perform the injection, the precise location of the needle tip, and factors that affected the accuracy of the injection were also assessed.
Results: A standardized anterior landmark-guided glenohumeral joint injection was performed in the operating room prior to surgery, and the location of the needle tip was documented by arthroscopic visualization with a low complication profile and few barriers to implementation. A total of 81 patients were enrolled. Successful intra-articular glenohumeral needle placement by sports medicine and shoulder/elbow fellowship-trained orthopedic surgeons was confirmed in 93.8% (76/81) of patients. The average time to complete the procedure was 24.8 ​s. There were no patient-related variables associated with nonintra-articular injections in the cohort.
Conclusions: This study demonstrated that the technique of anterior landmark-guided glenohumeral injection has an accuracy of 93.8% and requires less than 30 ​s to perform. This method is safe, yields similar accuracy to image-guided procedures, has improved cost and time efficiency, and requires less radiation exposure. No patient-related factors were associated with inaccurate needle placement. Anterior landmark-guided glenohumeral injections may be utilized with confidence by providers in the clinical setting.
Level of Evidence: Level 5. IRB: Approved under Stanford IRB-56323.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Geoffry Abrams, MD reports a relationship with Orthofix Medical Inc that includes: funding grants. Geoffrey Abrams, MD reports a relationship with Smith and Nephew Inc that includes: funding grants. Geoffrey Abrams, MD reports a relationship with Sparta Bio that includes: equity or stocks. Geoffrey Abrams, MD reports a relationship with AxGen that includes: equity or stocks. Geoffrey Abrams, MD reports a relationship with Cytonics Inc that includes: equity or stocks and non-financial support. Geoffrey Abrams, MD reports a relationship with Arthrex Inc that includes: non-financial support. Geoffrey Abrams, MD reports a relationship with Stryker Orthopedics that includes: non-financial support. Geoffrey Abrams, MD reports a relationship with RobiconMD that includes: non-financial support. Geoffrey Abrams, MD reports a relationship with Bioventus that includes: non-financial support. Michael T. Freehill, MD reports a relationship with Conmed that includes: funding grants. Michael T. Freehill, MD reports a relationship with Smith and Nephew Inc that includes: consulting or advisory. MIchael T. Freehill, MD reports a relationship with Stryker Orthopedics that includes: consulting or advisory. Michael T. Freehill, MD reports a relationship with Sparta Bio that includes: equity or stocks. Tim Wang, MD reports a relationship with Overture Orthopedics that includes: equity or stocks. Tim Wang, MD reports a relationship with Micah that includes: non-financial support.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)