Shoulder

ANTERIOR APPROACH Insert the needle just lateral to the coracoid process. This technique is performed with the patient sitting in an upright position, facing the examiner. The needle is directed posteriorly between the coracoid process and the humeral head. Because of the difficulty in locating the coracoid process, a posterior approach to the glenohumeral joint may be preferable in some patients.

POSTERIOR APPROACH Sit the patient upright with his or her back toward you. The spine of the scapula is palpated to its lateral limit: the acromion. The posterolateral corner of the acromion is located. The point for needle insertion lies 1 cm inferior and 1 cm medial to the posterolateral corner of the acromion ( Fig

278-1). A 12-in needle is directed anterior and medial toward the presumed position of the coracoid process. The glenohumeral joint is located at a depth of 1

approximately 1 to 12 in.

FIG. 278-1. Arthrocentesis of the shoulder, posterior approach.

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