MR arthrography of the shoulder: tolerance evaluation of four different injection techniques

Skeletal Radiol. 2013 Jan;42(1):99-105. doi: 10.1007/s00256-012-1526-y. Epub 2012 Oct 14.


Objective: We sought to prospectively evaluate patients' pain perception and technical success of four different arthrographic techniques for shoulder MR arthrography.

Materials and methods: A total of 125 consecutive patients were referred for shoulder MR arthrography. The patients were randomly injected under fluoroscopic guidance (n(1) = 37), with CT guidance using an anterior (n(2) = 29) or a posterior approach (n(3) = 32) and with ultrasound guidance (n(4) = 27). For each patient, absolute periprocedural pain on a numerical rating pain scale (0 = "no pain", 10 = "intolerable pain"), technical success of the method used, and reason for referral were recorded.

Results: The technical success rate was 100% for all injection methods. The results regarding absolute periprocedural pain were as follows: fluoroscopic guidance showed a mean pain of 4.05 ± 1.24, CT anterior guidance demonstrated a mean pain of 3.87 ± 0.95, CT posterior guidance showed a mean pain of 1.59 ± 0.81, and ultrasound guidance a mean pain of 3.63 ± 1.12. A significant difference (p < .05) was observed for the posterior route under CT guidance. The mean pain level was significantly higher for older (> 51 year) female patients.

Conclusions: No differences were found for the technical success rate of the aforementioned techniques. A CT-guided posterior approach seems to be a more comfortable method for the patient.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Analysis of Variance
  • Contrast Media
  • Female
  • Fluoroscopy
  • Gadolinium DTPA
  • Humans
  • Joint Diseases / diagnosis*
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Pain Measurement
  • Prospective Studies
  • Radiography, Interventional
  • Shoulder Joint*
  • Statistics, Nonparametric
  • Tomography, X-Ray Computed
  • Ultrasonography, Interventional


  • Contrast Media
  • Gadolinium DTPA