title: Accuracy of in vivo palpation-guided acromioclavicular joint injection assessed with contrast material and fluoroscopic evaluations.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the accuracy of in vivo acromioclavicular (AC) joint injections without fluoroscopic guidance and assess whether patient demographics affected the accuracy of injections.
  
  
  METHODS
  A consecutive cohort of patients who presented with painful acromioclavicular joints was prospectively evaluated. All patients had clinical and radiographic evidence of AC arthritis, had failed conservative measures, and thus had received intraarticular corticosteroid injections. All injections were performed by experienced fellowship-trained musculoskeletal radiologists and by blinded digital palpation technique. Accuracy of injections was assessed with biplanar fluoroscopic views.
  
  
  RESULTS
  Forty-one AC injections in 22 males and 16 females with a mean age of 51 years (range 18 to 78) were identified. Twenty-three injections were in the right shoulder and 18 in the left. Only 15 injections were confirmed to be in the intraarticular AC joint, yielding an accuracy of 36.5%. There were no significant differences in the mean age (54 vs. 52 years; p = 0.58), male-to-female ratio (p = 0.73), and side of the injection between the accurate and inaccurate injections, respectively.
  
  
  CONCLUSIONS
  Based on the findings of the present study, the authors encourage the use of image guidance for corticosteroid treatment of the AC joint.
  
  
  METHODS
  Level IV Therapeutic Case Series.
authors.affiliation: School of Health and Medical Sciences, Department of Orthopaedic Surgery, Seton Hall University, 400 South Orange, South Orange, NJ, 07079, USA, anthonyjscillia@gmail.com.
authors.forename: Anthony
authors.initials: A
authors.lastname: Scillia
authors.forename: Kimona
authors.initials: K
authors.lastname: Issa
authors.forename: Vincent K
authors.initials: VK
authors.lastname: McInerney
authors.forename: Edward
authors.initials: E
authors.lastname: Milman
authors.forename: Romulo
authors.initials: R
authors.lastname: Baltazar
authors.forename: Umer
authors.initials: U
authors.lastname: Dasti
authors.forename: Anthony
authors.initials: A
authors.lastname: Festa
mesh_terms: D000173:Acromioclavicular Joint / Q000000981:diagnostic imaging* / Q000187:drug effects; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods; D008297:Male; D008875:Middle Aged; D010173:Palpation / Q000379:methods*; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D003287:Contrast Media
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