Optimizing scapulothoracic injections: the role of hand positioning in enhancing procedural ease

Introduction: Pathologies of the scapulothoracic articulation may lead to painful symptoms such as crepitus and bursitis. While conservative treatments are preferred, persistent symptoms may require image-guided injections. This study aims to determine the optimal hand positioning during ultrasound to maximize the distance between the scapula and thoracic wall, and improve its accessibility during injections.

Methods: This cross-sectional observational study included ten healthy adult volunteers without scapulothoracic issues or history of trauma/surgery. Two musculoskeletal radiologists independently measured the scapulothoracic distance on Ultrasound in three hand positions: 1. Hands under the head; 2. Hands by the side of the trunk; and 3. Hands hanging by the side of the couch. Data was analyzed using SPSS 24.0. Continuous variables were described using mean and standard deviation (SD), with significance set at p < 0.05.

Results: Measurements on 20 scapulothoracic articulations (10 volunteers) showed the following findings: Position 1: Baseline value of 1. Position 2: Distance increased by 1.515 mm ± 3.617 (95% CI [- 0.0178, 3.208]. Position 3: Distance increased by 2.175 mm ± 0.66 (95% CI [0.793, 3.557]. Statistical analysis indicated no significant difference (p = 0.39) between positions. However, both radiologists subjectively noted that positions 2 and 3 provided better access for interventions.

Conclusion: This study highlights the importance of hand positioning in optimizing the scapulothoracic distance for therapeutic interventions. While no significant statistical differences were found, the results suggest potential benefits for clinical practice. Further research with larger samples is needed to establish evidence-based guidelines for scapulothoracic injections.