Journal CME, June 2023: Comparing fluoroscopic versus ultrasound guidance in glenohumeral joint aspiration-Comparing fluoroscopic versus ultrasound guidance in glenohumeral joint aspiration

Comparing fluoroscopic versus ultrasound guidance in glenohumeral joint aspiration

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The study aimed to compare the efficacy of fluoroscopic and ultrasound guidance in glenohumeral joint aspiration. Joint aspiration is a technique used for diagnosing shoulder joint issues. Fluoroscopy and ultrasound are image-guidance methods used to improve the accuracy of this procedure. This retrospective cohort study reviewed 206 patient cases from a single academic orthopedic clinic. These patients underwent glenohumeral aspiration primarily to exclude infection.<br /><br />The primary goal was to determine which method (fluoroscopy or ultrasound) was more successful in obtaining at least 0.1 mL of joint fluid. The secondary goal was to assess which method obtained a greater volume of fluid. The outcomes showed no significant difference between the two methods in terms of the success rate (fluoroscopy 70.6% and ultrasound 69.4%) or the volume of fluid obtained. Statistical analysis indicated that older age slightly increased the probability of obtaining fluid, whereas sex and whether the patient had an arthroplasty were not significant factors.<br /><br />However, a sub-analysis revealed that for patients with a Body Mass Index (BMI) of 35 or higher, fluoroscopy was more effective than ultrasound in aspirating larger volumes of fluid. Ultrasound guidance, despite being office-based, less expensive, and generally less uncomfortable, might not be as effective in obese patients due to signal attenuation and deeper tissue layers. <br /><br />The study concluded that while both methods are similarly successful overall, fluoroscopy may have an edge in obese patients. Nonetheless, further prospective studies are recommended to solidify these findings and better guide the choice of method based on patient characteristics and practitioner expertise.<br /><br />The CME activity associated with the study indicates that high BMI (≥35) is the factor most associated with greater fluid aspiration under fluoroscopic guidance.

Keywords

fluoroscopic guidance

ultrasound guidance

glenohumeral joint aspiration

shoulder joint diagnosis

retrospective cohort study

fluid aspiration success

BMI impact

fluoroscopy vs ultrasound

orthopedic clinic

image-guidance methods