Magnetic resonance imaging in glenohumeral instability

Table 2 Arthrographic techniques and their drawbacks

Arthrographic technique	Procedure	Advantages	Drawbacks
Indirect	Intravenous injection of gadolinium and imaging 10 min after active exercise of the joint	Simple	Joint cavity distension not achieved; ligamentous pathologies not well detected
		Does not involve intra-articular injection
Direct arthrography: anterior approach	Dilute gadolinium injected in the joint cavity through an anterior approach (US- or fluoroscopy-guided). Injection made through a point at the junction of the upper two-thirds and lower–third of anterior joint space	Adequate joint distension helps detection of labral and ligamentous pathologies better	Needs expertise
			May cause injury to the anterior stabilizing structures
			Carries the risk of intra-articular infection (though rare)
Direct arthrography: posterior approach	Dilute gadolinium injected in the joint cavity through a posterior approach (US- or fluoroscopy-guided)	Adequate joint distension helps detection of labral and ligamentous pathologies better	Needs expertise
		May be helpful in anterior instability, to avoid injury to anterior structures	May cause injury to posterior structures
			Carries the risk of intra-articular infection (though rare)
Direct arthrography: anterosuperior approach	Dilute gadolinium injected in the joint cavity through an anterosuperior approach in the RCI (US- or fluoroscopy-guided)	Adequate joint distension helps detection of labral and ligamentous pathologies better	Needs expertise
			May cause injury to the rotator interval capsule