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.
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.
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.
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.
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