Eur Radiol (2009) 19: 722–730 DOI 10.1007/s00330-008-1200-x M U S C U L O S K E L E TA L Matthieu J. C. M. Rutten James M. P. Collins Bas J. Maresch Jacques H. J. M. Smeets Caroline M. M. Janssen Lambertus A. L. M. Kiemeney Gerrit J. Jager Received: 30 June 2008 Accepted: 19 September 2008 Published online: 29 October 2008 # The Author(s) 2008 M. J. C. M. Rutten (*) . C. M. M. Janssen . G. J. Jager Department of Radiology, Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL ‘s-Hertogenbosch, The Netherlands e-mail: m.rutten@jbz.nl Tel.: +31-73-6992000 Fax: +31-73-6992601 e-mail: c.janssen@jbz.nl e-mail: g.jager@jbz.nl J. M. P. Collins Department of Radiology, Medical Centre Leeuwarden, H. Dunantweg 2, 8934 AD Leeuwarden, The Netherlands e-mail: j.collins@znb.nl B. J. Maresch Department of Radiology, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands e-mail: mareschb@zgv.nl Glenohumeral joint injection: a comparative study of ultrasound and fluoroscopically guided techniques before MR arthrography J. H. J. M. Smeets Department of Radiology, Slingeland Hospital, Kruisbergseweg 25, 7009 BL Doetinchem, The Netherlands e-mail: jsmeets@planet.nl L. A. L. M. Kiemeney Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Geert Grooteplein Noord 21, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands e-mail: b.kiemeney@ebh.umcn.nl Abstract To assess the variability in accuracy of contrast media introduc- tion, leakage, required time and pa- tient discomfort in four different centres, each using a different image- guided glenohumeral injection tech- nique. Each centre included 25 consecutive patients. The ultrasound- guided anterior (USa) and posterior approach (USp), fluoroscopic-guided anterior (FLa) and posterior (FLp) approach were used. Number of in- jection attempts, effect of contrast leakage on diagnostic quality, and total room, radiologist and procedure times were measured. Pain was docu- mented with a visual analogue scale (VAS) pain score. Access to the joint was achieved in all patients. A suc- cessful first attempt significantly oc- curred more often with US (94%) than with fluoroscopic guidance (72%). Leakage of contrast medium did not cause interpretative difficulties. With US guidance mean room, procedure and radiologist times were signifi- cantly shorter (p < 0.001). The USa approach was rated with the lowest pre- and post-injection VAS scores. The four image-guided injection techniques are successful in injection of contrast material into the glenohu- meral joint. US-guided injections and especially the anterior approach are significantly less time consuming, more successful on the first attempt, cause less patient discomfort and obviate the need for radiation and iodine contrast. Keywords Ultrasound . Fluoroscopy . Shoulder . Image- guided injection . MR arthrography Introduction Deposition of contrast media into the glenohumeral joint may be a challenge for some radiologists. According MR arthrography is frequently performed in the assessment to the numerous publications on this subject, it is still an of shoulder problems [1]. Intra-articular injection of a item of investigation [2–20]. There are various techniques gadolinium chelate or a saline solution improves the from blind [4,17,19] to image guided [2,3,10,12]. Gleno- detection of rotator cuff tears and demonstration of the humeral injections are generally performed using an labrum [1]. anterior approach under fluoroscopic guidance, which