How to Perform Subacromial Injection: Step-by-Step Technique

Subacromial injection is a key treatment for shoulder problems like bursitis and impingement syndrome. At Liv Hospital, we focus on the right technique and knowing the body’s landmarks. This ensures the best results for patients.

We teach a step-by-step method for subacromial injections. The lateral approach is the most common. It uses a 23-25 gauge needle, usually 1.5 inches long, based on the patient’s body.

Key Takeaways

• Subacromial injection is a critical procedural skill for managing shoulder pain.
• Proper technique and landmark identification are key for the best results.
• The lateral approach is the most commonly used method.
• A 23-25 gauge needle, 1.5 inches in length, is typically used.
• Patient anatomy and procedural preference guide needle selection.

Understanding Subacromial Injection Fundamentals

Learning about subacromial injections is key to managing shoulder problems. These injections help treat issues like subacromial bursitis and rotator cuff tendinopathy.

Clinical Indications and Therapeutic Benefits

Subacromial injections are mainly used to reduce pain and swelling in the shoulder. They offer enhanced mobility and less pain, helping people get back to their daily tasks. Research shows they can greatly help those with subacromial bursitis.

Anatomy of the Subacromial Space

The subacromial space is complex, with the subacromial bursa, rotator cuff tendons, and acromion. Knowing the anatomy is vital for precise injections. The subacromial bursa helps lessen friction between the rotator cuff and the acromion.

Ultrasound-Guided vs. Landmark-Guided Approaches

There are two main ways to do subacromial injections: ultrasound-guided and landmark-guided. Ultrasound-guided injections are more accurate and safer. Studies show they work better than landmark-guided methods.

Ultrasound guidance makes injections more accurate and safer. It lets doctors see the needle and surrounding areas in real-time. This ensures the injection is placed correctly.

Preparation for Subacromial Injection

To make sure the subacromial injection is safe and works well, we need to prepare everything carefully. This includes the right equipment and making sure the patient is in the right position. It’s all about making the procedure a success and keeping the patient comfortable and safe.

Required Equipment and Medication Selection

We need a few things for the injection, like sterile gloves, drapes, and a special needle. StatPearls says we should use a 25 or 27 gauge needle for cortisone shots. This size needle is just right for not hurting too much and getting the medicine where it needs to go.

The medicine we use is a mix of corticosteroid and local anesthetic. It’s about 6-7 mL. This mix helps with swelling and pain. We pick the right medicine based on what the patient needs and their health history.

Patient Positioning and Preparation

Getting the patient in the right spot is key for a successful injection. They should be sitting or lying down so we can easily reach their shoulder. We want them to be as comfortable and calm as possible to avoid moving during the shot.

• Make sure the patient is sitting comfortably with their arm by their side.
• Find the important landmarks, like the acromion process.
• Clean the skin with an antiseptic to lower infection risk.

Sterile Technique and Safety Considerations

Keeping everything clean and sterile is very important to avoid infections. We use sterile gloves, drapes, and tools. We also need to be careful not to hit any tendons or other sensitive areas.

Important safety tips include:

1. Use sterile equipment to lower infection risk.
2. Avoid hitting tendons or other sensitive areas.
3. Know the patient’s medical history and any allergies they might have.

Step-by-Step Subacromial Injection Technique

To give a subacromial injection, healthcare pros need to know the lateral approach. This method puts the medicine right in the subacromial bursa. It helps ease shoulder pain and swelling.

Lateral Approach Landmark Identification

Finding the right landmarks is the first step. We look for the posterolateral edge of the acromion. Feeling the acromion helps us find the spot.

• Find the posterolateral edge of the acromion.
• Mark the spot about 1-2 cm below it.

Getting the landmarks right is key for a successful injection. We must mark the spot correctly to avoid problems.

Proper Needle Insertion and Directional Guidance

After finding the landmarks, we insert the needle. The needle goes toward the opposite nipple. This makes sure the medicine goes into the right place.

1. Put the needle in at the marked spot.
2. Guide it toward the opposite nipple.
3. Check for blood before injecting to avoid blood vessels.

Medication Administration and Injection Technique

With the needle in place, we give the medicine. We use a mix of corticosteroid and local anesthetic. Injecting slowly helps avoid pain and spreads the medicine evenly.

• Give the medicine mix.
• Inject slowly to avoid pain.

Post-Injection Care and Patient Instructions

After the injection, we tell patients how to care for themselves. Watching for side effects and telling them what activities to avoid are important.

1. Tell them to rest for 24-48 hours.
2. Watch for signs of infection or bad reactions.
3. Guide them on handling side effects.

By following these steps and caring for patients after, we make the injection more effective. This helps patients feel better.

Conclusion

Understanding the subacromial space anatomy is key to a successful injection. We’ve shown how to do it step by step. This includes getting the patient ready, inserting the needle, and giving the medication.

The posterior shoulder injection is great for many shoulder problems. It helps by following a clean technique and caring for the patient well. This way, doctors can avoid complications and get better results.

We talked about how important it is to place the needle correctly. Using ultrasound helps make the injection more precise. As medical experts, we need to keep improving and learning new ways to help our patients.

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 References:

National Center for Biotechnology Information. Evidence-Based Medical Insight. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC4062801/