Efficiency of Axillary Bolster Use for Ultrasound-Guided Glenohumeral Joint Injection in MR Arthrography

The purpose of this study was to prospectively evaluate the accuracy of the ultrasonography (US)-guided posterior injection technique using an axillary bolster for magnetic resonance (MR) arthrography of the shoulder joint.

This study included 60 patients (30 US-guided injections with an axillary bolster, 30 US-guided injections without an axillary bolster). There were 37 men and 23 women whose ages ranged from 17 to 64 years (mean, 36.87 years). All procedures were performed by two radiologists with less than 1 year of experience in arthrographic procedures. The accuracy of the two injection techniques was compared. Extraarticular contrast material leak was graded according to the MR arthrography findings. The number of injection attempts and the effect of contrast material extravasation rate on diagnostic quality were recorded.

There were no significant differences between US-guided punctures with and without an axillary bolster in regard to pain (p = 0.39). Injections with an axillary bolster had a higher likelihood of success on the first attempt (p = 0.0031). Complete extravasation in the US-guided posterior approach technique without an axillary bolster was significantly higher than the US-guided posterior injection technique with an axillary bolster (p < 0.0001).

Although there is no significant difference in pain scores for both techniques, complete contrast material extravasation is seen at a higher rate in the US-guided posterior approach injection technique without the use of an axillary bolster compared to the technique used.