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Aids to Successful Shoulder Arthrography Performed with a Fluoroscopically Guided Anterior Approach¹

¹ From the Department of Radiology, University of Michigan Medical Center, 1500 E Medical Center Dr, TC-2910G, Ann Arbor, MI 48109-0326. Received April 26, 2002; revision requested May 29 and received June 14; accepted June 14. Address correspondence to J.A.J. (e-mail: jjacobsn@umich.edu).

View larger version (189K): [in a new window]   Figure 1.  Normal left shoulder in an 18-year-old man. MR image (400-msec repetition time, 21-msec echo time) obtained with fat saturation pulse sequences after intraarticular administration of gadolinium shows high-signal-intensity contrast material distending the glenohumeral joint and long head of the biceps brachii tendon sheath (arrowhead). Note the oblique orientation of the glenoid articular surface (curved arrow) and medial location of the anterior labrum (straight arrow) relative to the humerus.

View larger version (133K): [in a new window]   Figure 2.  Left shoulder in a 55-year-old man. With the shoulder placed in an oblique position to visualize the glenohumeral joint in profile, a 20-gauge spinal needle was inserted from an anterior approach directly into the joint without contact of the humeral head. Axial computed tomographic (CT) image obtained after injection of air and contrast agent demonstrates the path of the needle through the anterior labrum (open arrow) with its tip at the base of the posterior labrum (solid arrow).

View larger version (132K): [in a new window]   Figure 3a.  Right shoulder in a 54-year-old man. (a) Anteroposterior fluoroscopic image demonstrates a spinal needle (arrow) centered over the needle hub, just lateral to the medial cortex of the humeral head. Note the sclerotic line, which approximates the lateral border of the glenohumeral joint (arrowheads). (b) Anteroposterior fluoroscopic image shows the needle (arrow), which is angled medially toward the glenohumeral joint space after making contact with the humeral head. (c) Anteroposterior fluoroscopic image demonstrates intraarticular contrast material visualized between the glenoid and humerus (arrow).

View larger version (133K): [in a new window]   Figure 3b.  Right shoulder in a 54-year-old man. (a) Anteroposterior fluoroscopic image demonstrates a spinal needle (arrow) centered over the needle hub, just lateral to the medial cortex of the humeral head. Note the sclerotic line, which approximates the lateral border of the glenohumeral joint (arrowheads). (b) Anteroposterior fluoroscopic image shows the needle (arrow), which is angled medially toward the glenohumeral joint space after making contact with the humeral head. (c) Anteroposterior fluoroscopic image demonstrates intraarticular contrast material visualized between the glenoid and humerus (arrow).

View larger version (136K): [in a new window]   Figure 3c.  Right shoulder in a 54-year-old man. (a) Anteroposterior fluoroscopic image demonstrates a spinal needle (arrow) centered over the needle hub, just lateral to the medial cortex of the humeral head. Note the sclerotic line, which approximates the lateral border of the glenohumeral joint (arrowheads). (b) Anteroposterior fluoroscopic image shows the needle (arrow), which is angled medially toward the glenohumeral joint space after making contact with the humeral head. (c) Anteroposterior fluoroscopic image demonstrates intraarticular contrast material visualized between the glenoid and humerus (arrow).