Back

Do you think it makes a difference whether a surgeon uses imaging to inject the shoulder joint? My surgeon takes X-rays before but does the actual injection in the office just using visual guidance. From what I've found on the Internet, this method isn't as accurate as with using ultrasound or real-time X-rays.

According to the results of a recent systematic review, studies show that accuracy of joint injections can be improved. In the shoulder, coming in from behind (posterior approach) is more accurate than from the front (anterior approach). Additionally, the surgeon who uses ultrasound, fluoroscopy (real-time X-ray), or magnetic resonance imaging to guide the needle to the right spot will also be more accurate. And that was true for all joints (elbow, knee, or shoulder). X-rays taken before the procedure help the surgeon see if there are any anatomic changes, deformities, or problems like arthritis before making the actual injection. Real-time imaging during the actual procedure assists the surgeon in making sure the needle goes into the joint space. Taking a look at the larger (combined) sample created by the review, here's what they found for accuracy. With and without imaging to guide the surgeon showed differences of 79 per cent (without imaging) and 95 per cent (with imaging) for the shoulder. For the knee, accuracy improved from 79 per cent to 99 per cent. But does improved accuracy mean better results? Accuracy and benefit in terms of patient outcomes are two separate things. People who receive joint injections often improve regardless of the accuracy of the needle placement. The placebo effect (patient expects to get better and does) may have as much of a role in results as accurate placement.

« Back