Shoulder Injection

Shoulder Injection

1. Shoulder Injection Ade Wijaya, MD – September 2018 Reference: 2017 Atlas of Pain Management Injection Techniques

2. Outline Glenohumeral joint Acromioclavicular joint Supraspinatus tendon Infraspinatus tendon Subscapularis tendon Bicipital tendinitis Subacromial impingement syndrome Rotator cuff tear Frozen shoulder

3. Intra-Articular Injection of the Glenohumeral Joint

4. INDICATIONS AND CLINICAL CONSIDERATIONS The shoulder joint is susceptible to the development of arthritis Pain worse with activity, interfere sleep, crepitus might be found Limited ROM to do daily activities

5. Anatomy

6. Injection Site

7. USG-Guided Injection

8. Acromioclavicular Joint Injection

9. INDICATIONS AND CLINICAL CONSIDERATIONS The acromioclavicular joint is vulnerable to injury from both acute trauma and repetitive microtrauma Increased pain when reaching across the chest . Often the patient is unable to sleep on the affected shoulder

10. IMAGING

11. Injection Site

12. USG-Guided Injection

13. Supraspinatus Tendon Injection

14. INDICATIONS AND CLINICAL CONSIDERATIONS Shoulder prone to tendinitis due to: Wide range of motion Restricted by coracoacromial arch Poor blood supply Supraspinatus tendinitis usually acute, occurring after overuse or misuse of the shoulder joint Carrying heavy objects Vigorous use of exercise equipments Positive Dawbarn sign Often with bursitis

15. Dawbarn’s Test / Dawbarn Sign Pain on palpation over the greater tuberosity of the humerus when the arm is hanging down that disappears when the arm is fully abducted

16. Ultrasound

17. Ultrasound

18. Injection Site

19. Infraspinatus Tendon Injection

20. Ultrasound Normal Tendinopathy

21. Subscapularis Tendon Injection

22. Imaging

23. Injection Site

24. Long Head of the Biceps Injection for Bicipital Tendinitis

25. Anatomy

26. Physical Examination Yergason test, which is production of pain on active supination of the forearm against resistance with the elbow flexed at a right angle Popeye deformity

27. Ultrasound

28. Injection Site

29. Injection Technique for Subacromial Impingement Syndrome

30. INDICATIONS AND CLINICAL CONSIDERATIONS Diffuse shoulder pain with an associated feeling of weakness combined with loss of range of motion . Worsened at night and impair sleep I ncreasing shoulder pain with any activities that abduct and/or forward flex the shoulder Positive neer’s test

31. Anatomy

32. Etiology

33. MRI

34. Injection Site

35. USG-Guided Injection

36. Injection Technique for Rotator Cuff Tear

37. MR arthrogram

38. Injection Site

39. USG-Guided Injection

40. Injection Technique for Frozen Shoulder Syndrome

41. INDICATIONS AND CLINICAL CONSIDERATIONS The term frozen shoulder describes a constellation of clinical symptoms , including the unilateral progressive limitation of passive and active range of motion of the shoulder and pain on range of motion. Frozen shoulder is distinguishable from other painful conditions of the shoulder, such as tendinitis and bursitis, in that the limitation of range of motion associated with frozen shoulder affects both passive and active range of motion, whereas tendinitis and bursitis affect only active range of motion.

42. Injection Site

43. Treatment

44. USG-Guided Injection