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Research Objectives
To test hypotheses that the Glenohumeral Acromioclavicular Portal (GAP) injection
technique is non-inferior, and superior in accuracy, to other anatomically guided
techniques for glenohumeral joint (GHJ) injections, and can be effectively taught
to resident physicians.
Design
Experimental/Pilot study.
Setting
Anatomy Laboratory.
Participants
Bilateral shoulders of 12 donor bodies (n=24).
Interventions
Glenohumeral Acromioclavicular Portal (GAP) injections and relevant anatomic landmarks
were described to a physiatry resident (trainee) by a sports medicine-trained physiatrist
(specialist). The specialist and trainee then independently injected 24 donor shoulders
with 3 mL of separate food coloring dyes. Martinez-Silvestrini's GAP injection procedure
was followed: a 25 gauge 1.5 inch needle was placed in the midpoint between the acromion
and coracoid process, and advanced with a ∼45° cephalocaudal and ∼45° mediolateral
angulation until bony contact was observed. An anatomist and trained assistant then
dissected each shoulder, exposing the GHJ.
Main Outcome Measures
The success of GAP injections was determined by direct visualization of dye in the
GHJ as follows: blue = specialist, yellow = trainee, green (mixed dyes) = specialist
and trainee, no coloring = neither specialist nor trainee (unsuccessful injection).
Results: Of 48 injections, inspection of dissected shoulders revealed the following
: the specialist successfully injected 22/24 shoulders (91.67%); the trainee successfully
injected 20/24 (83.33%) shoulders. Combined accuracy was 42/48 (87.5%); 19/24 (79.2%)
of shoulders were jointly injected by both the trainee and specialist; Both specialist
and trainee were unsuccessful at injecting one of the shoulders which was grossly
deformed.
Conclusions
The GAP technique was shown to have high accuracy when performed on 24 donor body
shoulders. Our data suggest that the GAP technique is non-inferior, and potentially
superior, in accuracy to traditional methods of anatomically guided intra-articular
shoulder injections (26.8-40% accuracy). Additionally, GAP injections can be taught
effectively to resident trainees. Further investigation appears warranted.
Author(s) Disclosures
No Disclosures.
Key Words
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Copyright
© 2022 Published by Elsevier Inc.
