I've seen two different surgeons now about getting my shoulder injected. One wants to go in from the front. The other says it's more accurate to go in from the back. Does it matter? Should I get a third opinion?
Joint injection and specifically the accuracy of needle placement is the focus of a recently published systematic review. In a review of this type, many studies with small numbers of patients are combined together to create a larger pool of data to analyze. The results are statistically more significant when conclusions can be drawn that affect hundreds rather than dozens of patients.
According to the results of this 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). In fact, the reported accuracy rate increased from 45 per cent injecting from the front to 85 per cent accuracy from the back.
Additionally, the surgeon who uses ultrasound, fluoroscopy, 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).
As with all procedures of this type, surgeon experience and technical expertise can make a difference as well. It may be helpful to know how many of these injections each surgeon has performed and the success rate using these two different approaches. A third opinion never hurts either.
Erika L. Daley, BS, et al. Improving Injection Accuracy of the Elbow, Knee, and Shoulder. In The American Journal of Sports Medicine. March 2011. Vol. 39. No. 3. Pp. 656-662.
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