Performing an Ultrasound Guided Glenohumeral Joint Injection
Ultrasound guided glenohumeral (GH) joint injections are used for the treatment of symptoms secondary to osteoarthritis (1). A palpation guided GH joint injection has an accuracy of 72.5% compared to a 92.5% success rate with an ultrasound guided injection (1). Typically, either corticosteroids or platelet rich plasma (PRP) are injected into the GH joint via ultrasound guidance. Ultrasound guided injections are also commonly done in treatment of adhesive capsulitis of the GH joint (5). This review will evaluate the steps in performing a GH joint using the posterior approach.
The posterior approach is commonly done to inject the GH joint. The patient is typically lying in the lateral decubitus position with the affected shoulder up (2). A pillow can be placed between the elbow and their body for comfort (7).
The provider will use a curvilinear 5-2mHz probe. A 22g or 25g needle is typically used for the procedure and can range between 1.5in to 2in needle length. The ultrasound probe will be placed transverse to the humeral head posteriorly and the glenoid rim should be visualized (3).
A needle stick is made just lateral to the ultrasound probe (7). The needle will be guided in an oblique lateral to medial approach with the ultrasound probe in plane with the needle (2,7). The image below shows the ultrasound image with the needle approach angle (2). The needle will need to traverse through the infraspinatus in order to enter the joint capsule (3). The bevel should be facing upward as it passes through the infraspinatus and then turned downward for the injection (7). The injectate will be directed between the posterior glenoid labrum and the hypoechoic articular cartilage of the humeral head (7).
The image below shows the distention of the labrum as the injectate goes in, giving the appearance of a comma (2). Providers should avoid needle puncture of the glenoid labrum, as this can cause the patient pain (6).
Ultrasound guided injections of the GH joint are more accurate than palpation guided GH joint injections. The injection can be done via the anterior and posterior approach. This review went over the posterior approach of the GH joint with ultrasound guidance. This injection can be done with either corticosteroids or PRP.
By Gregory Rubin, DO
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1) Aly, Abdel-Rahman, et al. “Ultrasound-Guided Shoulder Girdle Injections Are More Accurate and More Effective than Landmark-Guided Injections: A Systematic Review and Meta-Analysis.” British Journal of Sports Medicine, vol. 49, no. 16, Aug. 2015, pp. 1042–49. PubMed, https://doi.org/10.1136/bjsports-2014-093573
2) Rutten, Matthieu J. C. M., et al. “Glenohumeral Joint Injection: A Comparative Study of Ultrasound and Fluoroscopically Guided Techniques before MR Arthrography.” European Radiology, vol. 19, no. 3, Mar. 2009, pp. 722–30. PubMed, https://doi.org/10.1007/s00330-008-1200-x
3) Patel, Rina P., et al. “Ultrasound-Guided Interventions of the Upper Extremity Joints.” Skeletal Radiology, vol. 52, no. 5, May 2023, pp. 897–909. PubMed, https://doi.org/10.1007/s00256-022-04148-9.
4) Amber, Kyle T., et al. “Comparing the Accuracy of Ultrasound versus Fluoroscopy in Glenohumeral Injections: A Systematic Review and Meta-Analysis.” Journal of Clinical Ultrasound: JCU, vol. 42, no. 7, Sept. 2014, pp. 411–16. PubMed, https://doi.org/10.1002/jcu.22154.
5) Ammerman, Brittany M., et al. “Ultrasound-Guided Glenohumeral Corticosteroid Injection for the Treatment of Adhesive Capsulitis of the Shoulder: The Role of Clinical Stage in Response to Treatment.” Sports Health, Apr. 2023, p. 19417381231168799. PubMed, https://doi.org/10.1177/19417381231168799
6) Pourcho, Adam M., et al. “Ultrasound-Guided Interventional Procedures About the Shoulder: Anatomy, Indications, and Techniques.” Physical Medicine and Rehabilitation Clinics of North America, vol. 27, no. 3, Aug. 2016, pp. 555–72. PubMed, https://doi.org/10.1016/j.pmr.2016.04.0
7) Chen, Carl P. C., et al. “Ultrasound-Guided Glenohumeral Joint Injection Using the Posterior Approach.” American Journal of Physical Medicine & Rehabilitation, vol. 94, no. 12, Dec. 2015, pp. e117-118. PubMed, https://doi.org/10.1097/PHM.0000000000000366