Shoulder Injection Techniques
Shoulder injections are used for diagnostic, as well as therapeutic purposes. The common substances injected include corticosteroids and hyaluronans.
Corticosteroids are strong anti-inflammatory medications reducing swelling and inflammation.
Hyaluronans also have anti-inflammatory benefits, as well as coating pain receptors, stimulating endogenous synovial fluid production and lubrication effects.
Injections are often performed ‘blind’ (without image guidance) in the clinical setting. The more trained and skilled the clinician is, the more reliable and accurate the injection.
Glenohumeral joint injection
Used for pain relief of shoulder arthritis and frozen shoulder affecting the shoulder.
The patient sits with their arm resting at their side with the shoulder in neutral rotation resting on their lap. The sulcus between the head of the humerus and acromion is identified. The needle is inserted 2-3cm inferior andmedial to the posterolateral corner of the acromion and directed anteriorly towards the coracoid process.
The needle is inserted medial to the head of humerus, lateralto the coracoid process by 1cm and directed posteriorly at a slight superior and lateral angle. Again, an 18 gauge needle should slip into the joint completely and the injection have no resistance.
Subacromial Space injection
Used for pain relief of:
Bursitis (subdeltoid bursitis)
Rotator cuff impingement
The patient sits with their arm resting by their side, as above. The posterior edge of the acromion is recognised, then the needle is inserted inferior to the posterolateral acromion and directed laterally into the subacromial space, aiming for the anterolateral corner of the acromion. A long 18 gauge needle should 2-3cmanterior to the posterolateral corner of the acromion and the syringe plunger should push easily with no resistance during injection. If any resistance is encountered, the needle should be with drawn and readjusted aiming moresuperiorly under the acromion, as the common error is to inject into the rotator cuff. This should be avoided due to the proteolytic nature of corticosteroids.
Acromioclavicular joint injection
Long Head of Biceps (LHB) injection
Used for pain relief of biceps tendonitis where the long head of biceps is inflamed
This should be preformed under ultrasound guidance, as the biceps tendon is deep under the thick deltoid and impossible to ‘feel’ with the needle. Injecting the bicepstendon with a proteolytic steroid can also increase the risk of tendon rupture. Therefore, we prefer to use a hyaluronan (Ostenil) in young patients.