Shoulder arthrography.

Arthrography of the glenohumeral joint is an important diagnostic tool. The procedure is easy to perform and can be accomplished without significant complications in most individuals. If care is exercised in performing the arthrogram, inadvertent injection of the subacromial (subdeltoid) bursa and soft tissue extravasation of contrast material can be avoided. Mild patient discomfort following the procedure may be diminished if small amounts of xylocaine are added to the injection material. Double-contrast or single-contrast examination can be utilized, depending upon the nature of the suspected underlying process. Arthrography of the glenohumeral joint is most useful in delineating the presence of a complete tear of the rotator cuff. It is also valuable in investigating patients with partial (inner) tears of the cuff, adhesive capsulitis, previous anterior dislocations of the joint, and articular diseases. The procedure can define subtle abnormalities of the bicipital tendon and sheath, and can demonstrate the nature of periarticular soft tissue masses. Although it is expected that additional procedures, such as subacromial bursography and arthrography of the acromioclavicular joint will be advocated in the years to come, arthrography of the glenohumeral joint will remain the most important contrast examination of the abnormal shoulder.