Logo

Log In Sign Up |  An official publication of: American College of Emergency Physicians
Navigation
  • Home
  • Multimedia
    • Podcasts
    • Videos
  • Clinical
    • Airway Managment
    • Case Reports
    • Critical Care
    • Guidelines
    • Imaging & Ultrasound
    • Pain & Palliative Care
    • Pediatrics
    • Resuscitation
    • Trauma & Injury
  • Resource Centers
    • mTBI Resource Center
  • Career
    • Practice Management
      • Benchmarking
      • Reimbursement & Coding
      • Care Team
      • Legal
      • Operations
      • Quality & Safety
    • Awards
    • Certification
    • Compensation
    • Early Career
    • Education
    • Leadership
    • Profiles
    • Retirement
    • Work-Life Balance
  • Columns
    • ACEP4U
    • Airway
    • Benchmarking
    • Brief19
    • By the Numbers
    • Coding Wizard
    • EM Cases
    • End of the Rainbow
    • Equity Equation
    • FACEPs in the Crowd
    • Forensic Facts
    • From the College
    • Images in EM
    • Kids Korner
    • Medicolegal Mind
    • Opinion
      • Break Room
      • New Spin
      • Pro-Con
    • Pearls From EM Literature
    • Policy Rx
    • Practice Changers
    • Problem Solvers
    • Residency Spotlight
    • Resident Voice
    • Skeptics’ Guide to Emergency Medicine
    • Sound Advice
    • Special OPs
    • Toxicology Q&A
    • WorldTravelERs
  • Resources
    • ACEP.org
    • ACEP Knowledge Quiz
    • Issue Archives
    • CME Now
    • Annual Scientific Assembly
      • ACEP14
      • ACEP15
      • ACEP16
      • ACEP17
      • ACEP18
      • ACEP19
    • Annals of Emergency Medicine
    • JACEP Open
    • Emergency Medicine Foundation
  • About
    • Our Mission
    • Medical Editor in Chief
    • Editorial Advisory Board
    • Awards
    • Authors
    • Article Submission
    • Contact Us
    • Advertise
    • Subscribe
    • Privacy Policy
    • Copyright Information

Ultrasound-Guided Glenohumeral Joint Evaluation and Aspiration

By Arun Nagdev, MD | on June 15, 2016 | 0 Comment
Sound Advice
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version

Evaluation of the patient with the painful shoulder can be difficult in the emergency department. The septic glenohumeral joint, while less common than infections of the knee and hip (fewer than 10 percent of cases of septic arthritis), can be often difficult to diagnose.1 Among the myriad musculoskeletal pathologies that can present with a painful shoulder, detection of a septic glenohumeral joint is critical because delay to diagnosis has been shown to allow for irreversible cartilage damage leading to functional impairment. An infected glenohumeral joint can be easily missed because classic signs and symptoms are often not present, plain film imaging does not detect a joint effusion, and classic laboratory tests are insensitive and nonspecific for septic joints.2 Also, even when a septic glenohumeral joint is suspected clinically, landmark-based aspirations can be unsuccessful. Even in the hands of experienced orthopedic surgeons, the failure rates are up to 30 percent.3 Point-of-care ultrasound allows for both an accurate method to detect the presence of a glenohumeral joint effusion and also a simplified method for reliable joint aspiration.4

You Might Also Like
  • How to Perform Ultrasound-Guided Forearm Nerve Blocks to Provide Non-Drug Pain Relief for Acute Injuries
  • How to Perform Ultrasound-Guided Knee Arthrocentesis
  • Pain Control Using Ultrasound-Guided Superficial Cervical Plexus Block
Explore This Issue
ACEP Now: Vol 35 – No 06 – June 2016

Procedure

1. Evaluate the nonaffected glenohumeral joint.

To determine the patient’s normal anatomy, obtain clear ultrasound views of the patient’s nonaffected/contralateral glenohumeral joint. For simplicity, I recommend evaluation of the posterior glenohumeral joint space (the anterior approach can be more challenging). Place the ultrasound system in front of the patient and palpate the patient’s scapular spine to identify basic surface anatomy (see Figure 1). The low-frequency (5 to 1 MHz) curvilinear transducer should be placed parallel to the bed, probe marker pointing to the patient’s left and positioned just below the scapular spine. Slowly slide the transducer toward the humeral head. A clear image of the humeral head, glenoid, infraspinatus tendon, and glenohumeral joint space will be obtained on the ultrasound screen (see Figure 2). Gentle passive or active internal and external rotation of the patient’s forearm can help novice sonographers recognize the relevant anatomy.

Figure 1. Place the ultrasound system in front of the patient and palpate the patient’s scapular spine to identify basic surface anatomy.

(click for larger image)
Figure 1. Place the ultrasound system in front of the patient and palpate the patient’s scapular spine to identify basic surface anatomy.

Figure 2. Slowly slide the transducer toward the humeral head. A clear image of the humeral head, glenoid, infraspinatus tendon, and glenohumeral joint space will be obtained on the ultrasound screen.

(click for larger image)
Figure 2. Slowly slide the transducer toward the humeral head. A clear image of the humeral head, glenoid, infraspinatus tendon, and glenohumeral joint space will be obtained on the ultrasound screen.

2. Evaluate the affected glenohumeral joint.

Using the same technique as detailed above, examine the affected glenohumeral joint (see Figure 3). A joint effusion will be an anechoic effusion just above the humeral head and under the synovial membrane. Exact measurements of the effusion are not useful, and the patient’s clinical evaluation, in conjunction with the ultrasound examination, should help determine the need for synovial fluid analysis.

Pages: 1 2 3 | Single Page

Topics: AspirationDiagnosisEmergency DepartmentEmergency PhysicianEvaluationImaging & UltrasoundJoint PainMusculoskeletalPain & Palliative CarePatient CareProcedures and SkillsSeptic Glenohumeral JointShoulder

Related

  • 10 Essentials for Your Emergency Department Fanny Pack

    June 17, 2025 - 0 Comment
  • Case Report: Rapid Diagnosis of Acute Aortic Dissection with POCUS

    June 11, 2025 - 0 Comment
  • The Business Aspects of Establishing a Novel Service Line in the Emergency Department

    February 11, 2025 - 2 Comments

Current Issue

ACEP Now: June 2025 (Digital)

Read More

No Responses to “Ultrasound-Guided Glenohumeral Joint Evaluation and Aspiration”

Leave a Reply Cancel Reply

Your email address will not be published. Required fields are marked *


*
*

Wiley
  • Home
  • About Us
  • Contact Us
  • Privacy
  • Terms of Use
  • Advertise
  • Cookie Preferences
Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 2333-2603