Fluoroscopy-guided injections of the upper extremity: pearls and pitfalls

Fluoroscopy guidance is commonly utilized for injections in the upper extremity, with increased accuracy for injection placement compared to blind injection. Injection of the glenohumeral joint is the most commonly performed upper extremity procedure. However, there are a number of other sites which can be easily injected under fluoroscopy including the acromioclavicular joint, subacromial subdeltoid bursa, biceps tendon sheath, scapulothoracic bursa, elbow, wrist, first CMC joint, and pisotriquetral joint. Fluoroscopy can be used to guide injections into the glenohumeral, elbow, or wrist joints preceding MR arthrography. While there are technique similarities when injecting any of these sites, some particular approaches and pitfalls are unique to each anatomic site.