Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleDistances to the Subacromial Bursa From 3 Different Injection Sites as Measured Arthroscopically
Section snippets
Methods
Thirty patients were asked to participate in this study, which was approved by the institutional review board (Table 1). All patients had impingement syndrome, shoulder instability, or acromioclavicular joint symptoms. Patients with full-thickness rotator cuff tears were excluded. All patients were administered a general anesthetic before positioning and then were placed in the beach-chair position for evaluation. Traction was not used for portal placement. Standard arthroscopic portals were
Anterior
The mean distance to the subacromial bursa by the anterior approach was 2.9 ± 0.6 cm. The minimum was 1.8 cm, and the maximum was 4.2 cm.
Lateral
The mean distance to the subacromial bursa by the lateral approach was 2.9 ± 0.7 cm. The minimum distance recorded was 1.8 cm, and the maximum distance recorded was 4.3 cm.
Posterior
The mean distance to the subacromial bursa by the posterior approach was 5.2 ± 1.1 cm. The minimum distance was 3.2 cm, and the maximum distance was 7.5 cm.
Body Mass Index
The mean body mass index (BMI) was
Discussion
This study shows a fairly consistent distance from the skin to the subacromial bursa by both the anterior and lateral approaches. Both of these approaches are also within reach of a standard 22- or 25-gauge needle. These needles typically measure from tip to hub either 1 inch (2.54 cm) or 1.5 inches (3.81 cm). The posterior approach, however, seems to be out of reach of the standard needles used for injection. The mean distance posteriorly was 5.2 cm. This may contribute to inaccurate placement
Conclusions
The distance to the subacromial bursa from anterior and lateral approaches appears to be consistent and within reach of a standard 22- or 25-gauge needle. The distance to the subacromial bursa from a posterior approach appears to be almost double that of the anterior and lateral approaches and may not be reachable by standard 22- and 25-gauge needles in all patients. There appears to be no correlation between distances to the subacromial bursa from the anterior, lateral, or posterior approaches
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Cited by (11)
Injection Techniques in Musculoskeletal Medicine (with PAGEBURST Access): A Practical Manual for Clinicians in Primary and Secondary Care, Fourth Edition
2011, Injection Techniques in Musculoskeletal Medicine (with PAGEBURST Access): A Practical Manual for Clinicians in Primary and Secondary Care, Fourth EditionPosterior subacromial injections are superior in differentiating a rotator cuff from a biceps pathology: A cadaveric study
2020, Journal of OrthopaedicsCitation Excerpt :Kang et al., in 2008 in a randomized study observed a radiography-confirmed accuracy of 70% independent of the route: anterolateral, lateral or posterior.41 Sardelli et al. endorsed a longer needle for posteriorly directed subacromial injections.32 The accuracies of lateral and anterior approaches have ranged between 70 and 96% and 69–90% respectively.
Injection of the subacromial bursa in patients with rotator cuff syndrome a prospective, randomized study comparing the effectiveness of different routes: A prospective, randomized study comparing the effectiveness of different routes
2012, Journal of Bone and Joint SurgeryCitation Excerpt :As only one physician performed the injections, it is conceivable that faulty technique could explain the observed differences in injection accuracy and that the use of a different physician or multiple physicians to inject the subacromial bursa may have produced a different outcome. Sardelli and Burks31 measured the distances of the anterior, lateral, and posterior injection routes of the subacromial bursa in patients undergoing arthroscopy of the shoulder and found that the length of the needle necessary to enter the bursa was 5 cm for the posterior route, compared with only 3 cm for both the anterior and lateral routes. Those authors believed that fluid extravasation into the subacromial area from glenohumeral arthroscopy may have incorrectly increased the observed distances to the bursa, although the proportionate differences between injection routes would not have been affected.
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The authors report no conflict of interest.