Direct magnetic resonance (MR) shoulder arthrography: posterior approach under ultrasonographic guidance and abduction (PAUGA, 2013

Topics: Shoulder, Direct MR arthrography, Shoulder, US guidance

Authors: R.F. Grasso, E. Faiella, P. Cimini, R.L. Cazzato, G. Luppi, F. Martina, R. Del Vescovo and B. Beomonte Zobel


Purpose: This study was undertaken to assess the reliability of the posterior approach under ultrasonographic guidance (PAUGA), with the arm abducted, before performing direct magnetic resonance (MR) arthrography of the shoulder.

Materials and methods: A total of 111 (82 men, 29 women; mean age, 24 years) underwent direct MR arthrography of the shoulder. Patients were enrolled because of glenohumeral instability (n=71), chronic shoulder pain (n=25), suspicion of rotator cuff tear (n=13) and adhesive capsulitis (n=2). Patients were placed in the lateral position, on the contralateral side to that being examined; the arm of the shoulder undergoing the examination was placed in slight internal rotation with the hand under the contralateral armpit. A gadolinium-based solution was injected into the articular capsule under cryoanaesthesia and sonographic guidance. A posterior approach was systematically applied. For each patient, the number of injection attempts, room time, complications and pain, as recorded on a 10-point visual analogue scale (VAS), were noted. For quantitative parameters (room time and pain intensity), the mean and standard deviation (SD) were calculated.

Results: Direct MR arthrographies were performed successfully in all patients; no immediate or late major complications were observed. Fourteen patients (12.6%) reported temporary and self-limiting compromise of arm movements, and 13 patients (11.7%) reported a vagal reaction not requiring medication. In 102 cases (92%), the injection was successful at the first attempt, whereas in the remaining nine cases (8%), needle repositioning without any additional puncture was required to obtain clear sonographic depiction of the position of the needle tip. Mean room time was 7.2±1.4 min. Mean pain intensity was 3.2±0.4 on the 10-point VAS scale.

Conclusions: PAUGA is a reliable and rapid technique that is well tolerated by patients and easy for the radiologist to perform.

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