Xiexiang Shao1, Lewis L Shi2, Peng Wang1, Fangwei Zou1, Jianhua Wang3. 1. Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China. 2. Department of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, U.S.A. 3. Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China. Electronic address: wangjianhua@xinhuamed.com.cn.
Abstract
PURPOSE: To describe a transcoracoacromial ligament glenohumeral injection technique that does not require radiographic guidance and to explore the accuracy of this injection technique in patients with idiopathic adhesive capsulitis. METHODS: From February 2015 to April 2017, 89 consecutive patients (116 injections) with idiopathic adhesive capsulitis were included in the study. All of them received unguided glenohumeral injection via the transcoracoacromial ligament technique, and postprocedural fluoroscopic images were used to determine accuracy. The anterolateral corner of acromion, the superior lateral border of coracoid tip, and the curved depression of distal clavicle were identified. The needle entry site was located at the trisection point between the distal third and middle third of the superior lateral border of coracoid tip-curved depression of the distal clavicle line; needle trajectory was perpendicular to the plane formed by the 3 points, and the needle was advanced toward the humeral head. An injection was rated a success if the first fluoroscopic picture showed intra-articular contrast; it was rated a failure if contrast was not intra-articular or the needle needed to be redirected more than 2 times. RESULTS: Out of 116 injections, 111 (95.7%) were successful. For 5 failed injections, there was 1 shoulder with more than 3 redirections and 4 shoulders with no intra-articular contrast (the needle hit the coracoid process in 1 shoulder, the needle rested in the anterior glenoid labrum in 2 shoulders, and the needle was inserted into the subscapularis in 1 shoulder). CONCLUSIONS: The transcoracoacromial ligament glenohumeral injection technique is highly accurate and reproducible in patients with idiopathic adhesive capsulitis. LEVEL OF EVIDENCE: Level IV, therapeutic retrospective case series.
PURPOSE: To describe a transcoracoacromial ligament glenohumeral injection technique that does not require radiographic guidance and to explore the accuracy of this injection technique in patients with idiopathic adhesive capsulitis. METHODS: From February 2015 to April 2017, 89 consecutive patients (116 injections) with idiopathic adhesive capsulitis were included in the study. All of them received unguided glenohumeral injection via the transcoracoacromial ligament technique, and postprocedural fluoroscopic images were used to determine accuracy. The anterolateral corner of acromion, the superior lateral border of coracoid tip, and the curved depression of distal clavicle were identified. The needle entry site was located at the trisection point between the distal third and middle third of the superior lateral border of coracoid tip-curved depression of the distal clavicle line; needle trajectory was perpendicular to the plane formed by the 3 points, and the needle was advanced toward the humeral head. An injection was rated a success if the first fluoroscopic picture showed intra-articular contrast; it was rated a failure if contrast was not intra-articular or the needle needed to be redirected more than 2 times. RESULTS: Out of 116 injections, 111 (95.7%) were successful. For 5 failed injections, there was 1 shoulder with more than 3 redirections and 4 shoulders with no intra-articular contrast (the needle hit the coracoid process in 1 shoulder, the needle rested in the anterior glenoid labrum in 2 shoulders, and the needle was inserted into the subscapularis in 1 shoulder). CONCLUSIONS: The transcoracoacromial ligament glenohumeral injection technique is highly accurate and reproducible in patients with idiopathic adhesive capsulitis. LEVEL OF EVIDENCE: Level IV, therapeutic retrospective case series.