Original Article
Distances to the Subacromial Bursa From 3 Different Injection Sites as Measured Arthroscopically

https://doi.org/10.1016/j.arthro.2008.04.070Get rights and content

Purpose: The purpose of this study was to assess the distance for a standard needle to reach the subacromial bursa through 3 commonly used approaches. Methods: Thirty patients without associated rotator cuff tears underwent arthroscopic evaluation of the shoulder. The bursa was entered without shaving or altering of the bursa. By use of standard arthroscopic portals, a spinal needle was inserted from an anterior, lateral, and posterior position and measured to define the distance to the subacromial bursa from the skin. Results: The mean distance with anterior needle placement was 2.9 ± 0.6 cm. The mean distance with lateral needle placement was 2.9 ± 0.7 cm. The mean distance with posterior needle placement was 5.2 ± 1.1 cm. The mean body mass index for the group of patients was 27.5. The minimum was 18.7, and the maximum was 42.8. Conclusions: The distance to the subacromial bursa from the 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 and the patient's body mass index. Clinical Relevance: Given the relative distances measured to the subacromial bursa from the anterior, lateral, and posterior positions, clinicians may choose a longer needle to improve the accuracy of placement when approaching the subacromial bursa from a posterior position. Use of a standard-length needle will provide reasonable accuracy from the anterior and lateral positions.

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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The authors report no conflict of interest.

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