What is the landmark for glenohumeral (shoulder) joint injection?

From the Guidelines

The primary landmark for glenohumeral joint injection is the coracoid process. To perform the injection:

• Locate the coracoid process on the anterior shoulder.
• Mark a point 1 cm lateral and 1 cm inferior to the tip of the coracoid process.
• Insert the needle at this marked point, directing it posteriorly and slightly superiorly. Use a 21-gauge, 1.5-inch needle for most adults. Advance the needle until you feel a "pop" as it enters the joint space, typically at a depth of 1-2 inches. Aspirate to ensure you're not in a blood vessel, then inject the medication (commonly corticosteroids with or without local anesthetic) 1. This approach targets the rotator interval, a relatively avascular area, reducing the risk of neurovascular injury. The coracoid process serves as a reliable, easily palpable landmark, making this technique suitable for both experienced clinicians and those learning the procedure. Always use sterile technique and consider ultrasound guidance for increased accuracy, especially in patients with challenging anatomy or obesity 1. It is essential to note that the use of local anesthetics may help reduce discomfort during the procedure, and their application should be considered on a case-by-case basis, taking into account the patient's preferences and medical history 1. Additionally, patients with certain medical conditions, such as diabetes, should be informed about the potential risks associated with intra-articular injections, including transient hyperglycemia, and advised to monitor their glucose levels closely after the procedure 1.

From the Research

Landmark for Glenohumeral Joint Injection

The landmark for glenohumeral (shoulder) joint injection can be identified using various approaches, including:

• Anterior approach: The landmark is located just lateral to the coracoid and angled 45° toward the glenohumeral joint 2, 3, 4
• Anterior approach with acromioclavicular joint as landmark: The landmark is located at the acromioclavicular joint, with the needle inserted toward the humeral head 5
• Transcoracoacromial ligament approach: The landmark is located at the trisection point between the distal and middle thirds of the line formed by the superior lateral border of the coracoid tip and the curved depression of the distal clavicle 6

Key Findings

• The anterior approach has been shown to be accurate in placing the needle intra-articularly, with success rates ranging from 90.6% to 96% 2, 3, 4
• The anterior approach with acromioclavicular joint as landmark has been shown to be more accurate than the posterior approach, with a success rate of 94% 5
• The transcoracoacromial ligament approach has been described as a highly accurate and reproducible technique that can be done without imaging guidance 6

Injection Techniques

• The needle is inserted perpendicular to the triangular plane of the 3 points and then advanced toward the humeral head 6
• The needle is inserted at a 45° angle toward the glenohumeral joint, using a location just lateral to the coracoid 2, 3, 4