II. Indications
- Osteolysis of distal clavicle
- Osteoarthritis
- Acromioclavicular Separation (Refractory Pain)
III. Preparation
- Needle: 25-27 gauge, 1 to 1.5 inch
- Intraarticular Corticosteroid
- Methylprednisolone: 0.25 - 0.50 ml of 40 mg/ml or
- Betamethasone (Celestone Soluspan): 0.25 to 0.50 ml
-
Lidocaine 1% or Bupivicaine 0.5%: 0.5 ml
- Use additional 1-2 ml of Anesthetic first to raise a skin wheal over injection site
IV. Approach
- Images
- Patient positioning
- Patient sits with arm resting at side
- Shoulder externally rotated
- Landmarks: Identify AC joint
- Palpate clavicle to distal aspect
- Slight depression where clavicle meets acromion
- Ultrasound guided injection improves success from 40% to >90%
- Injected with sterile technique
- Insert needle from anterior and superior approach
- Direct needle inferiorly
V. 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]