97% accuracy of intra-articular glenohumeral injection with a modified (Delaware) posterior bone touch technique.
BACKGROUND
Unguided approaches have not demonstrated evidence of highly accurate intra-articular glenohumeral injections. The purpose of this study was to assess the accuracy of a posterior approach bone touch technique in conscious subjects without shoulder pathology as a first step in developing an accurate, reliable technique for use in patients.


METHODS
Twenty-six young subjects (age 22-26) without shoulder pathology (BMI 24 +/- 3), had bilateral shoulders injected while awake and seated. A 20 gauge 3.5-inch needle was introduced 1.5 cm below the scapular spine mid-way between the posterior lateral acromial corner and the posterior axillary crease. In Trial I, 20 shoulders were injected. After touching the humerus, the arm was oscillated. The needle advanced to 4-5 cm and 10 mL of dye injected. Pop and ease of flow were recorded. Immediate room change, spot fluoroscopy, and independent experienced radiology reading followed. In Trial II, 32 shoulders were injected. The technique was modified to touching the humerus, externally rotating the arm 25 degrees, and while remaining in bone contact, delivering 10 mL of dye. The same data as Trial I was recorded.


RESULTS
In Trial I, 14/20 (70 percent) had dye within the glenohumeral joint. Five of seven failures were too anterior showing dye around the subscapularis muscle and all were associated with a pop. In Trial II, 31/32 (97 percent) had dye within glenohumeral joint. Twenty-three of 32 (72 percent) had a "pop," including the failure. Overall, 45/52 (87 percent) had dye within glenohumeral joint. Thirty-one of 52 (71 percent) of all shoulders had a "pop." Twenty-three of 52 (44 percent) shoulders had pain, resolving within 24 hours.


CONCLUSIONS
A modified (Delaware) posterior bone touch technique for glenohumeral joint injection is 97 percent accurate in conscious healthy young subjects. Pop and ease of flow are not always indicative of correct needle placement. This study serves as an important first step in determining an optimum approach for injecting pathologic glenohumeral joints with corticosteroids or hyaluronic acid.


METHODS
IV Case Series.
Tufts Medical Center, Boston, Mass, USA.
Jeremie M
JM
Axe
First State Orthopaedics, Newark, Del, USA.
Michael J
MJ
Axe
D000328:Adult; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006811:Humerus; D007270:Injections, Intra-Articular / Q000379:methods*; D007479:Iopamidol / Q000008:administration & dosage; D008297:Male; D010173:Palpation; D015203:Reproducibility of Results; D012785:Shoulder Joint; D014110:Touch; D055815:Young Adult
D003287:Contrast Media; D007479:Iopamidol