Volume 2, 2016
|Number of page(s)||5|
|Published online||25 March 2016|
Comparison of accuracy of anterior and superomedial approaches to shoulder injection: an experimental study
Department of Orthopaedic Surgery, Faculty of Medicine, Thammasat University Hospital, Klong-Nueng, Klong-Luang, Pathumthani
* Corresponding author: firstname.lastname@example.org
Accepted: 20 December 2015
Introduction: We aimed to compare the accuracy between the standard anterior technique of shoulder injection and the new superomedial technique modified from Neviaser arthroscopic portal placement. Intra-articular placement, especially at the long head of biceps (LHB) tendon, and needle depth were evaluated.
Methods: Fifty-eight patients (ages 57 ± 10 years) requiring shoulder arthroscopy in the beach-chair position were recruited. Needle punctures for both techniques were performed by an experienced sports medicine orthopedist. Patients were anesthetized, and the shoulder placed in the neutral position. A single needle was passed through the skin, with only one redirection allowed per trial. The superomedial technique was performed, then the anterior technique. Posterior-portal arthroscopy determined whether needle placement was inside the joint. The percentage of intra-articular needle placements for each technique defined accuracy. When inside the joint, the needle’s precise location was determined and its depth measured. A marginal χ2 test compared results between techniques.
Results: The superomedial technique was significantly more accurate than the anterior technique (84% vs. 55%, p < 0.05). For superomedial versus anterior attempts, the LHB tendon was penetrated in 4% vs. 28% of patients, respectively, and the superior labrum in 35% vs. 0% of patients, respectively; the needle depth was 42 ± 7 vs. 32 ± 7 mm, respectively (all p < 0.05).
Conclusions: The superomedial technique was more accurate, penetrating the LHB tendon less frequently than the standard anterior technique. A small-diameter needle was needed to minimize superior labral injury. The superomedial technique required a longer needle to access the shoulder joint.
Key words: Accuracy / Shoulder injection / Superomedial approach / Neviaser
© The Authors, published by EDP Sciences, 2016
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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