Position the patient supine on the fluoroscopy table, and place the shoulder in external rotation. Place a sandbag on the fingers to help maintain this position.
Use a radiopaque instrument to localize the joint in a spot that is neither too lateral nor to medial.
The optimal position is on the superomedial humeral head at the level of the coracoid. Mark the skin at this site.
Prepare the overlying skin with antiseptic solution and place sterile drapes over the area.
Prepare the buffered lidocaine anesthetic solution.
Prepare the MR arthrography contrast solution.
Anesthetize the planned needle tract with buffered lidocaine solution.
Advance a 20 - 22 gauge spinal needle directly into the joint, keeping the needle perpendicular to the table until the needle tip contacts the humeral head.
Remove the stylet from the needle.
After dripping contrast into the needle hub to eliminate air, attach the contrast-filled tubing/syringe.
Inject a small mount of contrast to confirm intra-articular position. Contrast should flow freely away from the needle tip, with little resistance to injection.
Contrast will opacify the joint capsule, outline the articular surface, and may extend into the biceps tendon sheath.
Document the intra-articular position of your needle and injection with fluoroscopic spot views in external and internal rotation.
