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

We sought to prospectively evaluate patients' pain perception and technical success of four different arthrographic techniques for shoulder MR arthrography. A total of 125 consecutive patients were referred for shoulder MR arthrography. The patients were randomly injected under fluoroscopic guidance (n1 = 37), with CT guidance using an anterior (n2 = 29) or a posterior approach (n3 = 32) and with ultrasound guidance (n4 = 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. 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. 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. (orig.)