The following describes one common approach for performing a glenohumeral (shoulder) joint injection. Always adhere to sterile technique.
Procedure:
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Patient Positioning: Have the patient seated comfortably with their arm relaxed and internally rotated. This helps open the posterior joint space.
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Landmark Identification: Identify the posterolateral corner of the acromion. This is your primary anatomical landmark. Also, palpate for the coracoid process, which will serve as your anterior target.
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Sterile Preparation: Thoroughly cleanse the skin with an antiseptic solution (e.g., chlorhexidine or povidone-iodine) and drape the area in a sterile fashion.
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Needle Insertion: Insert an 18-gauge needle 2-3 cm inferior and medial to the posterolateral corner of the acromion.
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Needle Trajectory: Direct the needle anteriorly towards the coracoid process. The needle should be aimed toward the glenohumeral joint.
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Joint Entry: Advance the needle slowly until it enters the joint space. You should feel a "pop" or a decrease in resistance as you enter the joint.
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Aspiration: Aspirate to confirm intra-articular placement. If blood is aspirated, redirect the needle slightly.
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Injection: Once proper placement is confirmed, slowly inject the medication (e.g., corticosteroid with local anesthetic). The plunger should advance with ease and minimal resistance. Significant resistance suggests extra-articular placement, and the needle should be repositioned.
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Withdrawal and Bandaging: Withdraw the needle and apply a sterile bandage.
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Post-Injection Instructions: Advise the patient to rest the shoulder for 24-48 hours and to report any signs of infection (e.g., increased pain, redness, swelling, fever).
Important Considerations:
- Sterile Technique: Strict sterile technique is crucial to prevent infection.
- Anatomical Knowledge: A thorough understanding of shoulder anatomy is essential for accurate needle placement.
- Ultrasound Guidance: Ultrasound guidance can improve the accuracy of needle placement, especially in patients with complex anatomy or prior injections.
- Patient Comfort: Ensure the patient is comfortable throughout the procedure. Consider using a local anesthetic to minimize pain.
- Complications: Potential complications include infection, bleeding, nerve injury, and allergic reaction to the medication. Discuss these with the patient beforehand.
- Alternatives: If the joint is difficult to access with an 18 gauge needle, consider starting with a smaller 22 gauge and then using that as a guide to introduce the larger needle.
Disclaimer: This information is for educational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional before undergoing any medical procedure.
