MR imaging after therapeutic injection of the subacromial bursa |
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Authors: | Nancy M Major |
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Institution: | (1) Duke University Medical Center, Department of Radiology, Division Musculoskeletal, Durham, NC 27710, USA, US |
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Abstract: | Objective. As a therapeutic injection into the subacromial bursa (SAB) is commonly performed for impingement syndrome, it is important
to know whether this fluid can be retained for a period of time and cause confusion with a pathologic collection of fluid.
This study identifies and describes the appearance of recent subacromial injection using MR imaging, and the appearance of
a potential complication.
Design and patients. Fourteen asymptomatic shoulders were studied with MR imaging using fast spin echo T2-weighted imaging (1.5 T) prior to injection
with 7 cm3 of xylocaine. Four shoulders had subacromial fluid and were eliminated from the study. The remaining 10 (9 men, 1 woman;
age range 27–36 years, average age 33 years) were then re-imaged immediately, and at 6, 12 and 24 h after the injection or
until fluid resolved. Each set of images was reviewed for the presence of fluid in the SAB and for additional abnormalities.
Results. Fluid was identified in all subjects in the SAB in the immediate, 6 and 12 h post-injection images. At 24 h, fluid was not
identified within the SAB in eight of 10 patients. In one patient fluid resolved in 48 h. The other continued to demonstrate
fluid in the SAB and in the joint as well as abnormal signal in the infraspinatus muscle from a presumed myositis. Imaging
was performed up to 10 days after the injection in this patient.
Conclusions. It is known that fluid identified in the SAB without evidence of a cuff tear may be due to bursitis. However, if MR imaging
is performed within 24 h of injection, the presence of the fluid may be iatrogenic. In addition, the history of recent therapeutic
injection is very important as complications such as myositis can occur as a result of the injection. Knowledge of injection
prior to imaging is vital for accurate interpretation of MR shoulder examinations.
Received: 14 May 1999 Revision Requested: 22 July 1999 Revision Received: 11 August 1999 Accepted: 18 August 1999 |
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Keywords: | Subacromial bursa Injection Myositis |
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