Ultrasound Knowledge Quizzes: Part 2

In our Ultrasound Knowledge Quizzes series, we will show you ultrasound images of patients along with a quiz question. Can you answer the questions correctly? Can you correctly diagnose your patients, find pathologies, or solve cases? Check how much you know now!

Case 2: MSK Ultrasound

A 67-year-old female with left shoulder pain and stiffness for 4 months, unresponsive to exercise, was diagnosed with moderate glenohumeral osteoarthritis based on an X-ray. She agreed to an ultrasound-guided cortisone injection. The ultrasound revealed mild bicep tendon sheath effusion with the rotator cuff intact. See the procedure below and answer our question!

How can you make sure that the cannula tip is placed correctly when doing injections into the glenohumeral joint?

A) Palpating the coracoid process and the humeral head

B) I ensure my correct cannula placement by choosing an anterior approach    

C) Making sure to keep the cannula tip in the imaging plane with subtle transducer movements    

D) Visualization of the injectant spreading laterally in the joint space. The spread inside the joint capsule can usually be well visualized with ultrasound

See below for the detailed answer – or learn more right away in our MSK BachelorClass or MSK Ultrasound of the Shoulder Joint course!

Detailed answer

The correct answers are C and D.

Palpating the coracoid process and the humeral head helps locate landmarks to guide needle insertion, but it does not confirm cannula placement. The anterior approach can be used, however it does no guarantee correct placement. In this video, for example, a posterior approach is used. Keeping the cannula tip in the imaging plane ensures you can track its progress and confirm its position relative to the joint. Subtle movements of the transducer allow for continuous visualization. Visualization of the injectant spreading in the joint space is the most definitive way to confirm the cannula tip placement. It also confirms that the medication is being delivered into the correct location. Also, you will see a "flash" at the end of the injection! By the way, this video shows an example of a posterior approach (medial to lateral) – even though this is a very common approach, there are other ones - All of them can be done with ultrasound guidance!

Can you correctly place the cannula tip when doing injections into the glenohumeral joint? In situations like this, it is helpful to have seen such images and cases before – and you can see so many in our MSK Ultrasound BachelorClass and MSK Ultrasound of the Shoulder Joint course! Start now with your free lectures – we are sure you can already learn something there!

Happy learning!