title: Accuracy of glenohumeral joint injections: comparing approach and experience of provider.
abstract: BACKGROUND
  The purpose of this study was to prospectively evaluate the accuracy of three different approaches used for glenohumeral injections. In addition, the accuracy of the injection was compared to the experience and confidence of the provider.
  
  
  METHODS
  One-hundred six consecutive patients with shoulder pain underwent attempted intra-articular injection either posteriorly, supraclavicularly, or anteriorly. Each approach was performed by an experienced and inexperienced provider. A musculoskeletal radiologist blinded to technique used and provider interpreted fluoroscopic images to determine accuracy. Providers were blinded to these results.
  
  
  RESULTS
  The accuracy of the anterior approach regardless of experience was 64.7%, the posterior approach was 45.7%, and the supraclavicular approach was 45.5%. With each approach, experience did not provide an advantage. For the anterior approach, the experienced provider was 50% accurate compared to 85.7%. For the posterior approach, the experienced provider had a 42.1% accuracy rate compared to 50%. The experienced provider was accurate 50% of the time in the supraclavicular approach compared to 38.5%. The providers were not able to predict their accuracy regardless of experience. The experienced providers, when compared to those who were less experienced, were more likely to be overconfident, particularly with the anterior and supraclavicular approaches.
  
  
  CONCLUSIONS
  There was no statistically significant difference between the 3 approaches. The anterior approach was the most accurate, independent of the experience level of the provider. The posterior approach produced the lowest level of confidence regardless of experience. The experienced providers were not able to accurately predict the results of their injections, and were more likely to be overconfident with the anterior and supraclavicular approaches.
authors.affiliation: University of Texas-Tyler/Trinity Mother Frances Primary Care Sports Medicine Fellowship Program, Tyler, TX, USA. Sportsdoc22@hotmail.com
authors.forename: Allison
authors.initials: A
authors.lastname: Tobola
authors.forename: Chad
authors.initials: C
authors.lastname: Cook
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Cassas
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hawkins
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Wienke
authors.forename: Stefan
authors.initials: S
authors.lastname: Tolan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kissenberth
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage; D002983:Clinical Competence; D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012785:Shoulder Joint / Q000000981:diagnostic imaging*; D016037:Single-Blind Method
chemical_list: D000779:Anesthetics, Local; D003287:Contrast Media; D005938:Glucocorticoids