II. Indications

  1. Bicipital Tendonitis

III. Preparation: Needle

  1. Needle: 27 gauge, 1 to 1.5 inch
  2. Corticosteroid
    1. Methylprednisolone: 0.25 ml of 40 mg/ml (10 mg) or
    2. Betamethasone (Celestone Soluspan): 0.5 ml of 6 mg/ml (3 mg)
  3. Lidocaine 1%: 1-2 ml

IV. Preparation: Patient positioning

  1. Patient sits with arm resting at side

V. Technique: Ultrasound-guided approach (preferred)

  1. Local Corticosteroid Injection at tendon sheath under Ultrasound guidance (see Shoulder Ultrasound)
  2. Approached in-plane to linear Ultrasound probe (probe short axis to anterior Shoulder - home position)
  3. Do not inject within tendon (and avoid circumflex artery within groove)

VI. Technique: Landmark-based approach

  1. Images
    1. OrthoShoulderInjectBiceps.jpg
    2. ShoulderAnteriorBiceps.jpg
  2. Landmarks
    1. Identify bicipital tendon in bicipital groove (proximal Humerus)
    2. Mark point of maximal tenderness over groove
  3. Injected with sterile technique (with Betadine preparation of skin)
    1. Direct needle parallel to bicipital groove (vertically oriented)
    2. Needle enters skin at 30 degrees oriented superiorly
    3. Do not inject bicipital tendon
    4. Infiltrate area around groove, but not into tendon
      1. Flow resisted when needle is inside tendon
      2. Withdraw needle slightly and retry
      3. Continue to withdraw until not in tendon

VII. Complications

  1. Bicipital tendon rupture
    1. Associated with intratendinous injection
    2. Do not inject bicipital tendon

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