Injections

SHOULDER INJECTIONS  

 

 

Injections are used regularly to treat shoulder conditions. A mixture of hydrocortisone, which has an anti-inflammatory action, and a local anaesthetic to numb the area are infiltrated.

Glenohumeral Joint

In the case of osteoarthritis, fluid within the joint can be drained to relieve pain and an anaesthetic and steroid injection put into the joint cavity to reduce pain and stiffness.

The most comfortable approach to use is a posterior one.

Acromioclavicular Joint.

Joint aspirate can be taken away and local anaesthetic and hydorcortizone put into the joint to relieve pain.

Subacromial Injection

This is used to reduce symptoms of impingement especially when the bursa is inflamed.

Biceps Tendon

Hydrocortizone is injected to reduce symptoms of tendonitis or partial tear.

It is advisable to avoid vigorous activity for one week after the injection.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Glenohumeral joint

    • Aspiration in acute arthritis
    • Injection in RA
    • Frozen shoulder
    • Osteoarthritis
    • 40-80mg of depomedrone and 0.5% Marcaine
    • Posterior or anterior approach
    • Posterior approach preferred-less apprehension and pain
    • Posteroanterior direction 1.5cm below and 1.5cm medial
    • To posterior corner of the acromion
    • No resistance

  • Anterior approach
  • Patient sitting with arm hanging at the side as landmarks are lost in recumbent position
  • Anteroposteriorly 1cm distal and 1cm lateral to the coracoid process

Subacromial bursa

  • Injection indicated in subacromial impingement and calcific tendinitis
  • 40mg depomedrone and 0.5% marcaine large volume
  • Posterolateral approach: aim anteromedially 40-45°upwards from postero-lateral corner under the acromion –no resistance

  • Anterior approach
  • More difficult
  • Requires infiltration with lignocaine first
  • Aim needle anteroposteriorly flush with the inferior surface of the acromion, 1cm lateral to the ACJ
  • Once the coracoacromial ligament is passed tissue resistance to injection ceases

Acromioclavicular joint

  • Aspiration in acute arthritis
  • Injection in OA, RA,Trauma
  • Diagnostic
  • Difficult procedure as the ACJ is very narrow with a partial meniscus
  • CLEAN ENVIRONMENT
  • X-Ray Fluoroscopy
  • Better in Hospital
  • Suspect a septic arthritis in IVDU and patients with recent subclavian catheter

Bicipital tendinitis

  • 20-40mg depomedrone and 0.5% Marcaine
  • aim tangentially to the tendon
  • inject under low pressure
  • integrity of the tendon may already be compromised and therefore tendon rupture is a possibility with direct injection of the tendon