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We do all our shoulder arthrograms

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now under ultrasound guidance.

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And we find this to be very effective and very easy.

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A couple of benefits of ultrasound guided arthrograms, one is no radiation.

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Two, it can be done anywhere.

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It doesn't have to be done in

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a specific floor or suite.

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It can be done right outside the MRI suite.

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Oftentimes, the floor or suite and where MRI is located

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are in completely different buildings.

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So it's sometimes difficult to coordinate all that.

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But with ultrasound guidance, it really can be done at the bedside before you wheel

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them into MRI, as long as you use sterile technique.

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So with that preamble out of the way,

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I want to show you the

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positioning of the needle along the joint.

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What you're looking at here is an axial image, in essence, coned down to

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the region of the shoulder joint.

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Here is the surface of your humeral head,

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the dark stuff here is the cartilaginous surface and this is the bony surface.

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And here is the needle tip.

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And I'm going to show you this video,

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pay close attention to this area.

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You can see, in fact, I'm going to move it back and forth

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to convince you that indeed that is the needle tip.

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Do you see that? That is the needle tip and that's

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exactly where you want to be.

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When your needle tip hits

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the cartilaginous or bony surface, you're going to feel

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a stop, a hard stop of that needle.

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That's how you know you're in the joint.

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And at this point, you'll inject contrast.

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And that contrast will go into your

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joint space over here.

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Let me show you what that looks like.

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Now here we are.

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The needle tip is going to be somewhere over here.

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We don't see it, but you're going

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to pay close attention to this area, which is the joint space.

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We see a couple of air bubbles here already, which is often unavoidable.

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So as I play the video, pay close attention to the twirlings over here.

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That's how we know we have contrast in the joint.

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Little more air bubbles have come through.

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Again, tiny microbubbles are unavoidable. And that's what it looks like.

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If you're ever unsure if you have contrast going into the joint,

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you can always put a little bit of color. Here's a little doppler box.

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As I inject contrast into the joint, look what happens.

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You can actually see the movement of fluid into the joint space.

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So that's a perfect example of movement of fluid in the joint.