Abstract：
OBJECTIVE: Image-guided ultrasound or fluoroscopic glenohumeral injections have high accuracy rates but require training, equipment, cost, and radiation exposure (fluoroscopy). In contrast, landmark-guided glenohumeral injections do not require additional subspecialist referrals or equipment. An optimal technique would be safe and accurate and have few barriers to implementation. The purpose of this study was to define the accuracy of glenohumeral needle placement via an anterior landmark-guided approach as assessed by direct arthroscopic visualization.
METHODS: A consecutive series of adult patients undergoing shoulder arthroscopy in the beach chair position were included in this study. Demographic and procedural data were collected. The time required to perform the injection, the precise location of the needle tip, and factors that affected the accuracy of the injection were also assessed.
RESULTS: A standardized anterior landmark-guided glenohumeral joint injection was performed in the operating room prior to surgery, and the location of the needle tip was documented by arthroscopic visualization with a low complication profile and few barriers to implementation. A total of 81 patients were enrolled. Successful intra-articular glenohumeral needle placement by sports medicine and shoulder/elbow fellowship-trained orthopedic surgeons was confirmed in 93.8% (76/81) of patients. The average time to complete the procedure was 24.8 s. There were no patient-related variables associated with nonintra-articular injections in the cohort.
CONCLUSIONS: This study demonstrated that the technique of anterior landmark-guided glenohumeral injection has an accuracy of 93.8% and requires less than 30 s to perform. This method is safe, yields similar accuracy to image-guided procedures, has improved cost and time efficiency, and requires less radiation exposure. No patient-related factors were associated with inaccurate needle placement. Anterior landmark-guided glenohumeral injections may be utilized with confidence by providers in the clinical setting.
METHODS: Level 5. IRB: Approved under Stanford IRB-56323.
METHODS: A consecutive series of adult patients undergoing shoulder arthroscopy in the beach chair position were included in this study. Demographic and procedural data were collected. The time required to perform the injection, the precise location of the needle tip, and factors that affected the accuracy of the injection were also assessed.
RESULTS: A standardized anterior landmark-guided glenohumeral joint injection was performed in the operating room prior to surgery, and the location of the needle tip was documented by arthroscopic visualization with a low complication profile and few barriers to implementation. A total of 81 patients were enrolled. Successful intra-articular glenohumeral needle placement by sports medicine and shoulder/elbow fellowship-trained orthopedic surgeons was confirmed in 93.8% (76/81) of patients. The average time to complete the procedure was 24.8 s. There were no patient-related variables associated with nonintra-articular injections in the cohort.
CONCLUSIONS: This study demonstrated that the technique of anterior landmark-guided glenohumeral injection has an accuracy of 93.8% and requires less than 30 s to perform. This method is safe, yields similar accuracy to image-guided procedures, has improved cost and time efficiency, and requires less radiation exposure. No patient-related factors were associated with inaccurate needle placement. Anterior landmark-guided glenohumeral injections may be utilized with confidence by providers in the clinical setting.
METHODS: Level 5. IRB: Approved under Stanford IRB-56323.
摘要：
目的：图像引导超声或荧光镜下的肱骨头注射具有较高的准确率，但需要训练,设备,成本,和辐射暴露（透视）。相比之下,地标引导的肱骨头注射不需要额外的亚专科转诊或设备。最佳技术是安全的，准确,并且几乎没有实施障碍。这项研究的目的是通过直接关节镜可视化评估，通过前界标引导入路确定肱骨针放置的准确性。
方法：本研究包括一系列连续的以沙滩椅姿势接受肩关节镜检查的成年患者。收集人口统计学和程序数据。进行注射所需的时间，针尖的精确位置，和影响注射准确性的因素也进行了评估。
结果：手术前在手术室进行标准化的前标志引导下的肱骨关节注射，并通过关节镜可视化记录针尖的位置，并发症发生率低，实施障碍少。共纳入81例患者。在93.8％（76/81）的患者中，证实了由运动医学和肩关节/肘关节团契训练的整形外科医生成功地放置了关节内肱骨针。完成该程序的平均时间为24.8秒。队列中没有与非关节内注射相关的患者相关变量。
结论：这项研究证明了一种前标志引导的肱骨前注射技术的准确性为93.8％，并且需要不到30秒的时间才能完成。这种方法是安全的，产生与图像引导程序相似的准确性，提高了成本和时间效率，更少的辐射暴露。没有患者相关因素与针头放置不准确相关。在临床环境中，提供者可以放心地使用前标志引导的肱骨注射。
方法：第5级。
方法：本研究包括一系列连续的以沙滩椅姿势接受肩关节镜检查的成年患者。收集人口统计学和程序数据。进行注射所需的时间，针尖的精确位置，和影响注射准确性的因素也进行了评估。
结果：手术前在手术室进行标准化的前标志引导下的肱骨关节注射，并通过关节镜可视化记录针尖的位置，并发症发生率低，实施障碍少。共纳入81例患者。在93.8％（76/81）的患者中，证实了由运动医学和肩关节/肘关节团契训练的整形外科医生成功地放置了关节内肱骨针。完成该程序的平均时间为24.8秒。队列中没有与非关节内注射相关的患者相关变量。
结论：这项研究证明了一种前标志引导的肱骨前注射技术的准确性为93.8％，并且需要不到30秒的时间才能完成。这种方法是安全的，产生与图像引导程序相似的准确性，提高了成本和时间效率，更少的辐射暴露。没有患者相关因素与针头放置不准确相关。在临床环境中，提供者可以放心地使用前标志引导的肱骨注射。
方法：第5级。
