Indications: Diagnostic and therapeutic purposes of –
- Shoulder impingement
- Supraspinatus tendinitis
- Subacromial bursitis
- Size: 5-10 ml
- Needle: 21 G
- Steroid: 0.5-1 ml Methylprednisolone (Depomedrol) 40 mg/ml
- Local anesthesia: 5-10 ml Lignocaine 1% or Bupivacaine 0.5%
Comfortably seated with the arm at the side and the hands resting on the lap.
- Identify posterolateral corner of the acromion.
- The needle should be inserted just inferior and lateral to the posterolateral corner of the acromion aiming slightly up and medial, toward the acromioclavicular joint.
- The needle should be felt to pass just beneath the acromion, and when placed within the bursa, it should be possible to gently sweep medial and lateral with little resistance.
- Aspirate prior to injection
- Fluid should flow freely into the bursal space when injecting, if not the needle is withdraw slightly to remove its tip from soft tissue while injecting.
- Identify and mark inferolateral margin of acronion.
- The needle should be inserted 1-1.5 inches below the middle of the acromion aiming slightly upwards. If the humeral head is contacted, withdraw and reinsert in a more superior direction.
- Direct the needle perpendicularly until the bone is reached and withdraw the needle 1-2 mm. At approximately 1 inch deep, needle should be in the subacromial bursa. To aim around supraspinatus tendon, position the needle over the anterior edge of the acromion.
- As in posterior approach, confirm the position of needle by aspirating and feeling of no resistance while injecting.