title: Accuracy of palpation-directed intra-articular glenohumeral injection confirmed by magnetic resonance arthrography.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Stetson Powell Orthopaedics and Sports Medicine, Burbank, U.S.A.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Powell
authors.affiliation: Stetson Powell Orthopaedics and Sports Medicine, Burbank, U.S.A.
authors.forename: Shane M
authors.initials: SM
authors.lastname: Davis
authors.affiliation: Pacific Advanced Radiology Medical Group, Van Nuys, California, U.S.A.
authors.forename: Emily H
authors.initials: EH
authors.lastname: Lee
authors.affiliation: Pacific Advanced Radiology Medical Group, Van Nuys, California, U.S.A.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Lee
authors.affiliation: Stetson Powell Orthopaedics and Sports Medicine, Burbank, U.S.A.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Sung
authors.affiliation: Stetson Powell Orthopaedics and Sports Medicine, Burbank, U.S.A.
authors.forename: Claire
authors.initials: C
authors.lastname: McGroder
authors.affiliation: Stetson Powell Orthopaedics and Sports Medicine, Burbank, U.S.A.
authors.forename: Shalen
authors.initials: S
authors.lastname: Kouk
authors.affiliation: Stetson Powell Orthopaedics and Sports Medicine, Burbank, U.S.A.. Electronic address: christopher.sy.lee@gmail.com.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000209:etiology; D001175:Arthrography; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010173:Palpation; D012189:Retrospective Studies; D017006:Rotator Cuff; D012785:Shoulder Joint / Q000473:pathology*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA