Extra-articular shoulder arthrogram injection (fluoroscopic guided)

Case contributed by Dr Dai Roberts

Presentation

Shoulder instability. For MR arthrogram.

Patient Data

Age: 35 years
Gender: Male
Fluoroscopy

Posterior approach: Injection of iodinated contrast

Images from a shoulder/ glenohumeral arthrogram injection.  

A 22G quincke is inserted targeting the inferomedial aspect of the humeral head.  The run of images shows iodinated contrast extending along the infraspinatus muscle and not extending into the joint. 

Fluoroscopy

Posterior approach: Injection of iodinated contrast and then injectate

The 22G quincke needle is repositioned and iodinated contrasts show an intra-articular needle tip position with it extending into the axillary recess.  The post-procedure image shows the arthrogram injectate has spread throughout the glenohumeral joint and into the long head of biceps tendon sheath.

Case Discussion

Shoulder/ glenohumeral arthrogram injections can be performed from an anterior or posterior approach.  

In a posterior approach, the needle is passed through the infraspinatus and if contrast or the arthrogram solution is injected into the infraspinatus muscle as demonstrated, it is unlikely to effect the diagnostic accuracy of the MR arthrogram.  This is opposed to an anterior approach through the rotator cuff interval, where the anterior cuff and anterior labrum are important aspects of the MRI in anterior shoulder instability and contrast in these structures would limit interpretation.  

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Case information

rID: 75570
Published: 1st Apr 2020
Last edited: 6th May 2020
Inclusion in quiz mode: Included
Institution: St. Paul's Hospital

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