Basic science
The influence of ultrasound guidance in the rate of success of acromioclavicular joint injection: an experimental study on human cadavers

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Background

Injections of the acromioclavicular joint (ACJ) are performed routinely in patients with ACJ arthritis, both diagnostically and therapeutically. The aim of this prospective controlled study was to estimate the frequency of successful intra-articular ACJ injections with the aid of sonographic guidance versus non-guided ACJ injections.

Materials and methods

A total of 80 cadaveric ACJs were injected with a solution containing methylene blue and subsequently dissected to distinguish intra- from peri-articular injections. In 40 cases the joint was punctured with sonographic guidance, whereas 40 joints were injected in the control group without the aid of ultrasound.

Results

The rate of successful intra-articular ACJ injection was 90% (36 of 40) in the guided group and 70% (28 of 40) in the non-guided group. Ultrasound was significantly more accurate for correct intra-articular needle placement (P = .025).

Discussion

The use of ultrasound significantly improves the accuracy of ACJ injection.

Section snippets

Materials and methods

A total of 80 ACJs (40 left and 40 right) from 40 cadavers (18 women and 22 men) with a mean age of 75.1 years (range, 54-91 years) at the time of death were used for this study. The cadavers were preserved by the method of Thiel18 at the Institute of Anatomy of the Medical University of Graz. This special embalming technique was developed over a period of 30 years. It preserves original color, consistency, and transparency of the tissues, as well as allows an almost full range of passive

Results

Of the 40 US-guided injections, 36 (90%) were intra-articular, whereas in the palpation group, only 28 of 40 injections (70%) were intra-articular (Fig. 3). Statistical analysis with a χ2 test shows a significant difference in the rate of intra-articular ACJ injection (P = .025). The overall success rate was 80% (64 of 80). We did not observe any correlations between the success of an injection and gender or side. Extra-articular injections of the US-guided group were placed superior to the

Discussion

The most important finding of this study was to show that the aid of US guidance significantly improves the accuracy of injections of the ACJ.

Injection of local anesthetics into the ACJ is frequently carried out to confirm diagnosis of symptomatic ACJ arthritis. Therefore, correct intra-articular needle placement is a prerequisite for the validity of this test. Peri-articular injection can lead to a misdiagnosis. According to Strobel et al,16 the presence of capsular hypertrophy on magnetic

Conclusions

The use of US guidance significantly improves the success rate in ACJ injection, and we recommend it for therapeutic ACJ injections in routine clinical practice.

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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Investigational Review Board approval was not required for this study.

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