II. Indications
- Bicipital Tendonitis
III. Preparation: Needle
- Needle: 27 gauge, 1 to 1.5 inch
-
Corticosteroid
- Methylprednisolone: 0.25 ml of 40 mg/ml (10 mg) or
- Betamethasone (Celestone Soluspan): 0.5 ml of 6 mg/ml (3 mg)
- Lidocaine 1%: 1-2 ml
IV. Preparation: Patient positioning
- Patient sits with arm resting at side
V. Technique: Ultrasound-guided approach (preferred)
- Local Corticosteroid Injection at tendon sheath under Ultrasound guidance (see Shoulder Ultrasound)
- Approached in-plane to linear Ultrasound probe (probe short axis to anterior Shoulder - home position)
- Do not inject within tendon (and avoid circumflex artery within groove)
VI. Technique: Landmark-based approach
- Images
- Landmarks
- Identify bicipital tendon in bicipital groove (proximal Humerus)
- Mark point of maximal tenderness over groove
- Injected with sterile technique (with Betadine preparation of skin)
- Direct needle parallel to bicipital groove (vertically oriented)
- Needle enters skin at 30 degrees oriented superiorly
- Do not inject bicipital tendon
- Infiltrate area around groove, but not into tendon
- Flow resisted when needle is inside tendon
- Withdraw needle slightly and retry
- Continue to withdraw until not in tendon
VII. Complications
- Bicipital tendon rupture
- Associated with intratendinous injection
- Do not inject bicipital tendon
VIII. References
- Pfenninger (1994) Procedures, p. 1036-54
- Larson (1996) Am Fam Physician 53(5):1637-43 [PubMed]
- Tallia (2003) Am Fam Physician 67(6):1271-8 [PubMed]