Learning objectives
We will describe the pathophysiology of various conditions of the shoulder that can be relieved with ultrasound (US)-guided steroid and anesthetic injections.
We will detail the step-by-step process of each injection,
with corresponding photographs.
We will discuss various tips and tricks that can ensure optimal efficacy and maximize patient satisfaction.
Background
Shoulder pain is a very common complaint and can be a source of discomfort for patients of all ages.
Pain attributed to degenerative and inflammatory etiologies can be relieved by utilizing targeted US-guided steroid and anesthetic injections.
These procedures can be performed in the outpatient setting and result in rapid symptomatic relief.
Examples of such etiologies include subacromial-subdeltoid bursitis,
adhesive capsulitis,
osteoarthritis,
as well as tendinopathy.
Subacromial-subdeltoid Bursitis
The subacromial-subdeltoid bursa (SASD) is a large synovial-lined potential space between the rotator cuff tendons,
deltoid muscle,...
Findings and procedure details
Equipment
Philips EQIP 7®Ultrasound Machine
12-5 MHz Linear Transducer
Remaining standard departmental equipment seen in Figures 6 and 7.
Pre-Procedural Preparation
The patient is brought into the ultrasound room,
and an adequate history is obtained.
A focused physical exam is performed is performed with evaluation of active and passive range of motion.
Dynamic sonographic evaluation of the rotator cuff is performed on each patient.
Risks and benefits of the procedure are explained and informed consent is obtained.
Standard Injection Preparation
After identifying the region of...
Conclusion
US-guided steroid and anesthetic injections are a relatively quick and minimally invasive method to relieve significant shoulder pain cause by various impingement,
inflammatory and degenerative conditions.
By utilizing certain tips and tricks,
we can ensure a positive patient experience during the procedure as well as after it,
leading to favorable outcomes for the clinician.
References
Draghi Fet al.
Prevalence of subacromial-subdeltoid bursitis in shoulder pain: an ultrasonographic study.
J Ultrasound.
2015;18(2):151-8.
Hsieh LFet al.
Is ultrasound-guided injection more effective in chronic subacromial bursitis? Med Sci Sports Exerc.
2013;45:2205–13.
Hsu JEet al.
Current review of adhesive capsulitis.
J Shoulder Elbow Surg.
2011;20:502–514.
Lee HJ et al.
Randomized controlled trial for efficacy of intra-articular injection for adhesive capsulitis: ultrasonography- guided versus blind technique.
Arch Phys Med Rehabil.
2009;90:1997– 2002.
Krupp RJet al.
Long head of the biceps tendon pain: differential diagnosis and...