Purpose
To arthroscopically evaluate the trans-coracoacromial ligament glenohumeral (GH) injection
technique by understanding intra-articular needle-tip placement and potential misplacement
and complications.
Methods
The technique relies on the palpation of 3 bony landmarks: anterolateral corner of
the acromion, superolateral border of the coracoid tip, and curved depression of the
distal clavicle. The skin entry site lies on the line connecting the curved depression
of the distal clavicle and superolateral border of the coracoid tip, two-thirds of
the way from the former and one-third of the way from the latter. The direction of
the needle is perpendicular to the triangle formed by the 3 bony landmarks. The technique
is used to insufflate the GH joint at the start of shoulder arthroscopy procedures
with patients in the beach-chair position. Saline solution is injected, and the position
of the needle tip in the GH joint is evaluated arthroscopically. An injection is considered
successful if saline solution can be injected and the needle tip can be visualized
intra-articularly.
Results
This study enrolled 195 patients undergoing shoulder arthroscopy. Successful needle
placement in the GH joint occurred in 179 patients (91.8%); placement occurred through
the rotator interval in 122 of these, adjacent or through the long head of the biceps
tendon in 41, through the upper subscapularis or anterior supraspinatus in 13, and
through the anterior labrum in 3. Regarding the 16 failures (8.2%), the needle position
did not allow saline solution to be injected because of high resistance in 3 patients
whereas the needle tip was not visualized in 13. The needle tip was presumed to rest
within the subscapularis muscle or tendon or the labrum in 10 failed injections.
Conclusions
The trans-coracoacromial ligament injection technique showed a high success rate (91.8%)
in anesthetized patients about to undergo arthroscopy, whereas the failed injections
mainly occurred because the needle was inserted into the subscapularis or labrum.
This technique can be used for awake patients with different diagnoses in multiple
settings.
Level of Evidence
Level IV, diagnostic study.
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Article info
Publication history
Published online: February 10, 2020
Accepted:
January 17,
2020
Received:
March 27,
2017
Footnotes
The authors report the following potential conflicts of interest or sources of funding: This work was supported by the National Natural Science Foundation of China (81171706). Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2020 by the Arthroscopy Association of North America
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Access this article on ScienceDirectLinked Article
- ErratumArthroscopyVol. 37Issue 4
- PreviewIn the article “Trans-coracoacromial Ligament Glenohumeral Injection With Arthroscopic Confirmation,” published in the June 2020 issue (Arthroscopy 2020;36:1535-1541), it should have been noted that Xiexiang Shao and Jibin Chen contributed equally and share first author status. The article has since been corrected online.
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