Extra-articular injection

Last revised by Dai Roberts on 29 Aug 2020

Extra-articular injections occur when the needle tip is not within the targeted joint during joint injections.

Defined by the presence of contrast outside of a joint in fluoroscopic or CT guided procedures, or the lack of direct visualization and resisted flow of intra-articular injectate during ultrasound-guided procedures.  

  • extra-articular injections should be identified when performing image-guided joint injections, to avoid subsequent injection of either arthrogram solution or steroid containing injectate outside of the joint
  • during fluoroscopic guided procedures, straight or linear spread during injection of contrast should alert the practitioner to an extra-articular injection
  • often extra-articular injections will have resistance and can be uncomfortable for the patient
  • adhesive capsulitis can cause resistance and poor joint capsule distension 1
  • the needle tip should be visualized throughout ultrasound-guided procedures to ensure accurate placement 2
  • patient positioning can dramatically change the ease of access into the joint i.e. supinated hand during anterior glenohumeral joint injections
  • the benefit of achieving and confirming an intra-articular facet joint injection is debated, as periarticular injections have been shown to have equivalent outcomes as intra-articular injections 3

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Cases and figures

  • Case 1: shoulder
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  • Case 2: hip
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  • Case 3: hip
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