Aids to successful shoulder arthrography performed with a fluoroscopically guided anterior approach

One method for performing effective shoulder arthrography with a fluoroscopically guided anterior approach is described. The technique can ensure success while injury to the cartilaginous labrum is avoided, which is essential when arthrography is performed in conjunction with magnetic resonance (MR) imaging. The key features of the technique include supine positioning of the patient with the shoulder in external rotation, marking the skin just lateral to the humeral head cortex, inserting the needle perpendicular to the fluoroscopy beam, testing the injection with an anesthetic agent, and confirming intraarticular needle placement with iodinated contrast material. The procedure can be followed by an injection of dilute gadolinium solution for subsequent MR imaging. Proper patient and needle positioning as well as accurate confirmation of intraarticular needle placement are critical to a successful and atraumatic shoulder arthrographic examination.