Shoulder Arthrogram Injection

Shoulder
Equipment & Medications

Equipment

9–14 MHz Linear Probe 6–8 MHz Curved (large habitus) 22g 3.5″ Spinal Needle 25g 1.5″ Needle 10 cc Syringe Procedure Tray

Medications

Lidocaine 1% — 10 cc Normal Saline — 10 cc Gadolinium — 0.1 cc
Procedure Steps
1

Standard pre-procedure workup: consent, indications, contraindications, allergies.

2

Position patient in lateral decubitus with contralateral shoulder down and arm in cross-adduction.

Lateral decubitus positioning Arm cross-adduction
3

Scan for the posterior glenohumeral joint space at the level of the infraspinatus tendon insertion in longitudinal orientation. Position probe to allow anterior needle approach.

Posterior glenohumeral joint space
Click for annotated view
4

Mark needle site and probable injection site.

5

Prep patient with betadine or chlorhexidine × 3.

6

Place sterile drape and sterile probe cover.

7

Draw up medications as listed. Prepare the gadolinium/saline mixture (10 cc NS + 0.1 cc Gd).

8

Inject 1% lidocaine superficially using the 25g 1.5″ needle under ultrasound guidance.

9

Exchange 25g needle for the 22g 3.5″ spinal needle.

10

Advance needle under ultrasound guidance to the level of the articular cartilage.

Needle advancing
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11

Test-inject with 1% lidocaine (up to 3–5 cc). If there is easy flow and joint distention, proceed. If resistance, reposition needle off cartilage.

Test injection positioning
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12

Exchange lidocaine syringe for the 10 cc Normal Saline + Gadolinium mixture. Inject the full 10 cc into the joint.

Arthrogram injection
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13

Document distention of the posterior joint recess with ultrasound.

Joint distension
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14

Clean the area and place a bandage over the entry site.

15

Send patient immediately for MRI.

References

  1. Zwar RB, Read JW, Noakes JB. Sonographically guided glenohumeral joint injection. AJR Am J Roentgenol. 2004;183(1):48–50.
  2. Roberts CC, Escobar E. Shoulder Arthrogram. In: StatPearls. StatPearls Publishing; 2025.
  3. Choudur HN, Ellins ML. Ultrasound-guided gadolinium joint injections for magnetic resonance arthrography. J Clin Ultrasound. 2011;39(1):6–11.