3. Aspirate the glenohumeral joint.

I recommend standard sterile precautions for all joint aspirations (sterile probe cover, sterile gloves, etc.). Use the M-mode marker to center the transducer over the space between the glenoid fossa and humeral head. Place a small anesthetic skin wheal at this location. With an 18–21 g, 3.5-inch spinal needle attached to a control syringe, advance the needle tip just parallel to the probe, just under the scapular spine (see Figure 4). The out-of-plane technique does not allow for clear needle visualization but offers a simplified method to enter the glenohumeral joint capsule. While advancing the needle, gently aspirate until synovial fluid is obtained.

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Figure 3. Using the same technique detailed in Figure 2, examine the affected glenohumeral joint.

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Figure 4. Use the M-mode marker to center the transducer over the space between the glenoid fossa and humeral head. With an 18–21 g, 3.5-inch spinal needle attached to a control syringe, advance the needle tip just parallel to the probe, just under the scapular spine.

Summary

Clinicians should be familiar with a simplified method for the ultrasonographic evaluation of the glenohumeral joint. The presence of a joint effusion on point-of-care ultrasound evaluation in the correct clinical setting will indicate the need for joint aspiration and fluid analysis. The out-of-plane posterior approach to glenohumeral aspiration allows for a simplified method for a safe and efficacious joint aspiration.

Contributors

Dennis Hsieh, MD, JD, Resident Physician, Highland General Hospital, Alameda Health System
Marcus Williams, MD, Resident Physician, Highland General Hospital, Alameda Health System
Daniel Mantuani, MD, MPH, Attending Physician, Assistant Director, Emergency Ultrasound, Highland General Hospital, Alameda Health System
Arun Nagdev, MD, Attending Physician, Director, Emergency Ultrasound, Highland General Hospital, Alameda Health System

Dr. Nagdev is director of emergency ultrasound at Highland Hospital and assistant clinical professor (volunteer) of emergency medicine at the University of California, San Francisco.

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3. Patel DN, Nayyar S, Hasan S, et al. Comparison of ultrasound-guided versus blind glenohumeral injections: a cadaveric study. J Shoulder Elbow Surg. 2012;21(12):1664-1668.
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