II. Indications
- Subacromial Bursitis (Subdeltoid Bursitis)
- Rotator Cuff Impingement or Tendinosis
- Adhesive Capsulitis
III. Efficacy
- After 30 weeks: Assessment moderate to severe pain
- Study of n=40, DBRT, with mean age of 57 years
- Subacromial Corticosteroid Injection: 16% had pain
- Subacromial Lidocaine injection: 71% had pain
- Blair (1996) J Bone Joint Surg 78A: 1685-9 [PubMed]
IV. Preparation
- Needle: 25-27 gauge 1.5 inch
- Intraarticular Corticosteroid
- Methylprednisolone: 1 ml of 40 mg/ml or
- Betamethasone (Celestone Soluspan): 1 ml or
- Triamcinolone Acetonide (Kenalog) 1 ml of 40 mg/ml
-
Anesthetic
- Lidocaine 1%: 5 ml and/or
- Bupivacaine 0.25%: 4 ml
V. Technique: Approach (Lateral Shoulder)
VI. Imaging: Ultrasound guidance
- Indications
- Obesity or otherwise obscured bony landmarks
- Otherwise landmarks are easily palpated and Ultrasound adds little to the procedure
- Obesity or otherwise obscured bony landmarks
- Technique
- High frequency, Linear-array probe (vascular, small parts, superficial)
- Vertically positioned over the lateral Shoulder with the superior aspect of the probe against the acromion
- Subacromial space access will be inferior to the acromion (identified by bone-related shadowing behind the acromion)
- References
VII. 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]