Improving injection accuracy of the elbow, knee, and shoulder: does injection site and imaging make a difference? A systematic review

Am J Sports Med. 2011 Mar;39(3):656-62. doi: 10.1177/0363546510390610. Epub 2011 Jan 21.


Background: Joint injections and aspirations are used to reduce joint pain and decrease inflammation. The efficacy of these injections is diminished when they are placed inadvertently in the wrong location or compartment. The purpose of this study was to determine whether the use of varying sites or imaging techniques affects the rate of accurate needle placement in aspiration and injection in the shoulder, elbow, and knee.

Hypotheses: (1) Accuracy rates of different joint injection sites will demonstrate variability. (2) Injection accuracy rates will be improved when performed with concomitant imaging.

Study design: Systematic review of the literature.

Methods: Studies reporting injection accuracy based on image verification were identified through a systematic search of the English literature. Accuracy rates were compared for currently accepted injection sites in the shoulder, elbow, and knee. In addition, accuracy rates with and without imaging of these joints were compared.

Results: In the glenohumeral joint, there is a statistically higher accuracy rate with the posterior approach when compared with the anterior approach (85% vs 45%). Injection site selection did not affect accuracy for the subacromial space, acromioclavicular joint, elbow, or knee. The use of imaging improved injection accuracy in the glenohumeral joint (95% vs 79%), subacromial space (100% vs 63%), acromioclavicular joint (100% vs 45%), and knee (99% vs 79%).

Conclusion: Injection accuracy rates are significantly higher for the posterior approach compared with the anterior approach for the glenohumeral joint. Similarly, the accuracy rates are also higher when imaging is used in conjunction with injection of the glenohumeral joint, subacromial space, acromioclavicular joint, and knee.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Arthrography
  • Elbow Joint*
  • Fluoroscopy
  • Humans
  • Injections, Intra-Articular / methods*
  • Knee Joint*
  • Magnetic Resonance Imaging
  • Reproducibility of Results
  • Shoulder Joint*
  • Ultrasonography, Interventional