MRA SHOULDER ARTHROGRAMS: HOW TO DO IT

1. Patient prone arm extended palm up and put a sand bag on the palm to hold it externally rotated.

2. Mark position at supero medial corner of humeral head around level of coracoid. Mark over the bone and not at the joint space.

Why at level of coracoid tip and not lower at inferior half of humeral head?
 

 

 Images Above: Low entry site will go through subscapularis tendon which can feel very firm and you think you have hit bone. But when you inject its extra articular still. Injecting at the level of the coracoid process avoids this.

3. Sterile technique 22 gauge needle (make sure you have a sharp tip needle like a Terumo needle. The standard spinal needles don’t cut well) push it vertically down over the marked spot until you feel bone. Sometimes subscap tendon can feel very firm so push until it won’t go further.
 
4. 3 ml syringe with iodinated contrast connected to a minimal volume tube. Connect to needle and inject under fluoro screening. Contrast should flow away either into sub-coracoid space (like image above) or into joint and inferiorly. There shouldn't be any resistance to injecting.
 
5. Once you have confirmed you are in joint, inject diluted gadolinium or saline (up to 10 mls).

• If using Gadolinium:

 
• If using Saline: 
  3 planes PD and PDFS