Ultrasound presents an alternative technique for shoulder joint cannulation. A posterior approach is most commonly employed with the probe held as an axial position. The target area is between the humeral head and the posterior labrum.

Fluoroscopic guided Shoulder Injection

A posterior approach is favoured for investigation of recurrent dislocation. An anterior approach is suggested when the indication is posterosuperior impingement or SLAP lesion. The patient should be lying in a comfortable position without too much external or internal rotation.

Regardless whether an anterior or posterior approach is chosen, the puncture point is over the target area in the upper inner quadrant of the humeral head.

The skin should be sterilised and local anaesthetic injected.

The needle is inserted at the puncture point and advanced vertically towards the target zone. Local anaesthetic should be instilled.

Once bone is reached, needle position should be checked to ensure that the tip is in the target zone.  Ask an assistant to gently rotate the arm during contrast injection as this helps to disseminate quickly throughout the joint and confirm intra-articular position.

For MR Arthrography ensure that at every stage syringes and reservoirs are clear of air bubbles.

Ultrasound guided Shoulder Injection

Joint distension arthrography can be employed to treat patients during the stiff, non-painful phase of adhesive capsulitis. Local anaesthetic mixed with contrast is injected until resistance is encountered and then a further volume is injected to stretch the joint.