Shoulder Arthrogram

Overview

Pre-Procedure Prep

Indications

• Evaluation for rotator cuff tears and labral injury
• Evaluation of shoulder instability and glenohumeral ligaments
• Adhesive capsulitis of the glenohumeral joint
• Persistent symptoms following surgery

Contraindications

• Infection

Pre-Procedural Evaluation

• Confirm joint and laterality
• Confirm anticoagulation status and history of allergies
• Confirm patient is safe to undergo MRI (pacemaker, spinal stimulator) prior to arthrogram

Procedure Steps

For MRI Arthrogram

• Draw up 5 cc contrast into a 20 cc syringe.
• Add 15 cc normal saline to the mixture.
• Can substitute portion of saline for ropivacaine or bupivacaine
• Withdraw 0.1 cc of Gadolinium in 1 cc syringe.
• Add the 0.1 cc of Gadolinium to the contrast mixture in the 20 cc syringe (dilution of 1:200)

Example of Arthrogram Solution

• 20 mL syringe containing: 10 mL saline, 5 mL ropivacaine 0.5%, 5 mL contrast & 0.1 mL Gadavist

Shoulder Arthrogram

• Position patient supine on the fluoroscopy table with shoulder in neutral or externally rotated position (as tolerated)
• Needle target under fluoroscopy is the rotator cuff interval, which is the upper medial quadrant of the humeral head. Position target in the center of field of view, magnify, and collimate.
• Prep and drape shoulder in sterile fashion.
• Administer 1% local lidocaine along expected course
• Use a straight down vertical approach to contact with the surface of the humeral head with 22-25 gauge needle
• Confirm joint position with injection of 1-2 mL contrast under fluoroscopy.
• When in the joint, contrast will flow away from the needle. If the contrast pools at the needle tip, then needle tip is not in the joint space
• Inject 8-12 mL of the gadolinium mixture into the joint space
• Following injection, remove needle and place bandage

Post-Procedure

Post-Operative Care

• Typically safe for patient to be discharged immediate following MRI or CT
• Educate patient on the signs of infection with instructions to call with any symptoms such as worsening pain or fever

Complications

• Vasovagal episode
• Failure to access joint space resulting in extra-articular contrast
• Infection