How is shoulder arthrocentesis performed with ultrasonographic guidance?

Updated: Nov 27, 2018
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Erik D Schraga, MD  more...
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Answer

Prevention of unnecessary arthrocentesis is possible through confirmation of the effusion with ultrasonography (US). Procedural success is increased, and potential damage to important structures (vessels, tendons, ligaments, and cartilage) is minimized with visualization of the needle tip. An ultrasound probe sheath, chlorhexidine for site preparation, sterile gloves, sterile gel, and sterile drape are required.

With US guidance, the posterior approach accessing the posterior glenohumeral recess is preferred. After the transducer is aligned in the long axis with the infraspinatus, the needle is advanced from lateral to medial (or vice versa) until its tip is positioned near the surface of the humeral head hyaline cartilage. [9]

There are advantages to both in-plane and out-of-plane approaches. An in-plane approach does not allow neighboring structures to be identified, but it does provide the advantage of visualizing the entire length of the needle. An out-of-plane approach makes visualizing the needle tip difficult, but it allows improved visualization of the surrounding structures. The choice of approach is determined by the preferences of the provider and the depth of the joint. The curvilinear probe is ideal for the shoulder. [10]

Accuracy rates are also higher when imaging is used in conjunction with injection and aspiration. In a randomized trial comparing US-guided with blind steroid injection in patients with adhesive capsulitis of the shoulder, Raeissadat et al found that US-guided injections yielded improved accuracy, pain relief, range of motion, and function; however, these improvements were not statistically significant. [11]  In addition, the use of US guidance was associated with higher cost and was more time-consuming.


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