Joint Steroid Injection

General Indications:

  • Chronic joint pain (due to rotator cuff tear, ligament tear, osteoarthritis...)
  • Impingement (to break the cycle of joint dysfunction -> impingemenet -> more dysfunction -> more impingement)
  • Bursitis

 Aim:

  • To reduce pain
  • To relieve inflammation
  • To facilitate rehab

Medications used:

  • Triamcinolone (Kenalog 40mg/1ml)
    • Alternatives: Betamethasone (Celestone Soluspan 6mg/ml) or Methylprednisolone (Depo-Medrol 40mg/1ml vial)
  • Lidocaine (Xylocaine 1% 10mg/ml)
    • Alternatives: Bupivacaine (Marcaine 0.5% 5mg/ml)

Locations of joint injections: 

Shoulder:

  • Sub-acromial bursa
  • Acromioclavicular joint
  • Gelnohumeral joint
  • Sheath of long head of biceps

 

Sub-acromial Injection

Indication:

  • Tendon Impingement
  • Rotator cuff tears

Patient population:

  • Excessive use of shoulder joint: patient with stroke, MS, patients in wheelchairs who must use their arms to get out of chairs and to propel the wheelchairs.

Dose:

  • Kenalog 20-40mg (0.5-1 ml) + Xylocaine 20mg (2ml)

Landmark:

  • 1cm below and medial to the posterior angle of the acromion process.

Source: https://www.youtube.com/watch?v=YXtQQAd4n1E

Technique:

  • Patient should be setting up with arms adducted (so weight of the arm will open the joint space)
  • Physician will be standing behind the patient, have the medications prepared in a 25G 3.5cm needle.
  • Palpate the spine of scapula and go laterally along the spine till you reach the posterior corner of the acromion. Slide your finger 1 cm below and medial to the posterior corner of acromion, you will feel a gap between the bony structures filled with soft tissue, the sub-acromial bursa. With needle facing antero lateral, insert the whole 3 cm needle and inject the medications.

Video: https://www.youtube.com/watch?v=YXtQQAd4n1E

 

Joint Injection Procedure Note

Date: *****
Time: *****
Indication: "Pain with joint movement"
Resident: *********
Attending : ************

The "Right" "Sub-acromial" joint was marked and then prepped in the usual sterile fashion. Using a 25 gauge 3.5 inch needle, "2 ml" of lidocaine and  "1 ml" of "Triamcinolone" were injected without difficulty. After injection, the joint was passively moved through the full range of motion and a sterile dressing was applied. The patient tolerated the procedure well. Aftercare was discussed.