Subacromial Space Injection

Aka: Subacromial Space Injection, Subacromial Corticosteroid Injection

1. See also
   1. Shoulder Injection
   2. Glenohumeral Joint Injection
   3. Acromioclavicular Joint Injection
   4. Long Head of Biceps Injection
   5. Joint Injection
   6. Injectable Corticosteroid
2. Indications
   1. Subacromial Bursitis (Subdeltoid Bursitis)
   2. Rotator Cuff Impingement or Tendinosis
   3. Adhesive Capsulitis
3. Efficacy
   1. After 30 weeks: Assessment moderate to severe pain
      1. Study of n=40, DBRT, with mean age of 57 years
      2. Subacromial Corticosteroid Injection: 16% had pain
      3. Subacromial Lidocaine injection: 71% had pain
      4. Blair (1996) J Bone Joint Surg 78A: 1685-9 [PubMed]
4. Preparation
   1. Needle: 25-27 gauge 1.5 inch
   2. Intraarticular Corticosteroid
      1. Methylprednisolone: 1 ml of 40 mg/ml or
      2. Betamethasone (Celestone Soluspan): 1 ml or
      3. Triamcinolone Acetonide (Kenalog) 1 ml of 40 mg/ml
   3. Anesthetic
      1. Lidocaine 1%: 5 ml and/or
      2. Bupivacaine 0.25%: 4 ml
5. Technique: Approach (Lateral Shoulder)
   1. Images
      1. 
   2. Landmarks
      1. Posterior and lateral aspect of Shoulder
      2. Inferior to lower edge of posterolateral acromion
   3. Injected with sterile technique
      1. Insert inferior to acromion at lateral Shoulder
      2. Direct needle toward opposite nipple
      3. Insert needle to full length
      4. Fluid should flow easily
6. Imaging: Ultrasound guidance
   1. Indications
      1. Obesity or otherwise obscured bony landmarks
         1. Otherwise landmarks are easily palpated and Ultrasound adds little to the procedure
   2. Technique
      1. High frequency, Linear-array probe (vascular, small parts, superficial)
      2. Vertically positioned over the lateral Shoulder with the superior aspect of the probe against the acromion
      3. Subacromial space access will be inferior to the acromion (identified by bone-related shadowing behind the acromion)
   3. References
      1. Dogu (2012) Am J Phys Med Rehabil 91(8): 658-65 [PubMed]
7. References
   1. Pfenninger (1994) Procedures, p. 1036-54
   2. Larson (1996) Am Fam Physician 53(5):1637-43 [PubMed]
   3. Tallia (2003) Am Fam Physician 67(6):1271-8 [PubMed]