Periprocedural Care
Patient Education and Consent
Before the procedure, the risks, benefits, and alternatives should be discussed with the patient. Informed consent should be obtained.
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Equipment
Equipment employed for subacromial injection includes the following:
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Sterile gloves
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Bactericidal skin preparation solution
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Needle, 1.5 in., 22-25 gauge
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Syringe, 10 mL
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Lidocaine 1% without epinephrine (or similar local anesthetic), 5 mL
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Corticosteroid, 1-2 mL (see Corticosteroid Injections of Joints and Soft Tissues)
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Sterile gauze
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Sterile adhesive
Additional equipment for either indirect or direct ultrasound-guided injections includes the following:
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Ultrasound device with 7.5-15 MHz linear-array broadband probe
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Sterile (direct approach) or nonsterile (indirect skin-marking approach) ultrasound gel
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Patient Preparation
Anesthesia
Cooling spray or local anesthetic may be used. If a local anesthetic is chosen, use a separate 25-gauge needle to raise a wheal at the site of the injection by inserting the needle about 1 cm below the skin surface. (See Local Anesthetic Agents, Infiltrative Administration.)
Positioning
The patient should be seated upright in a comfortable position with the arm hanging unsupported by the patient's side.
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Media Gallery
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Presence of contrast medium in subdeltoid-subacromial bursa signals presence of complete rotator cuff tear.
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Complete rotator cuff tear with presence of contrast medium in subacromial-subdeltoid bursa. Also note multiple irregularities in synovial fluid, shown as multiple filling defects.
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In 77-year-old woman with long history of chronic right shoulder impingement, posterior approach for subacromial injection is performed. Video courtesy of James R Verheyden, MD.
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Ultrasonogram shows needle penetrating bursa (right side of image) prior to injection of medication. Courtesy of Nicholas Goyeneche, MD, Ochsner Health System.
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