Ultrasound-Guided Glenohumeral Joint (Posterior Approach) Injection Technique

MATERIALS 22 or 21-gauge 3.5-inch spinal needle <10-MHz curvilinear transducer 25-gauge 1.5 inch or 27-gauge 1.5 inch for local anesthesia Local anesthetic, steroid, and/or other injectate Ultrasound probe cover Sterile ultrasound gel Chlora-prep or other skin antiseptic 4 × 4 gauze Band-Aid PATIENT POSITIONING The patient is placed in a lateral recumbent position with the uninjured shoulder on the table. The patient’s injured arm should be placed in a neutral position on their side. Before the procedure, passive shoulder internal and external rotation may be performed to make the glenohumeral joint space more conspicuous. The physician should position themselves such that the ultrasound screen is in their direct view. PROBE POSITIONING The posterior glenohumeral joint is localized in an oblique anatomic transverse view just below the spine of the scapula. This is in the same plane as long axis to the fibers of the infraspinatus muscle. NEEDLE TECHNIQUE The needle is introduced using an in-plane, lateral to medial approach toward the glenohumeral joint. The ideal final position of the needle is between the free margin of the posterior glenoid labrum and the hypoechoic articular cartilage of the humeral head or a posterior joint recess if present. For injections without an aspiration component, the final position of the needle can also be on the articular cartilage close to the glenohumeral joint so that it is intracapsular. PEARS AND PITFALLS Care should be taken to avoid puncture/scrape of the glenoid labrum or glenohumeral cartilage during the procedure. In addition, overdistension of the joint with injectate should be avoided as this can lead to pain or capsular rupture. Ultrasound-Guided Injection Video Series: Glenohumeral Joint Injection, https://links.lww.com/PHM/C598