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Injections about the shoulder

Injections about the shoulder. Mr Lee Van Rensburg November 2011. www.cambridgeses.co.uk. Injections about the shoulder. Subacromial space (bursa) ACJ – Acromioclavicular joint Bicipital groove (biceps tendon) Intra articular.

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Injections about the shoulder

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  1. Injections about the shoulder Mr Lee Van Rensburg November 2011 www.cambridgeses.co.uk

  2. Injections about the shoulder • Subacromial space (bursa) • ACJ – Acromioclavicular joint • Bicipital groove (biceps tendon) • Intra articular

  3. Corticosteroid Injection:They do work! Graeme Mackenziebmj.com, 17 Aug 2001 [Full text]Re: Corticosteroid Injection:They do work! Patrick J Edwardsbmj.com, 18 Aug 2001 [Full text]Suggestions should include change the needle after drawing up. Steve Searlebmj.com, 19 Aug 2001 [Full text]Shoulder tendon lesions and injections Andrew Bamjibmj.com, 22 Aug 2001 [Full text]Are Rotator Cuff tedinopathy diagnoses right? Bruce Graybmj.com, 22 Aug 2001 [Full text]A Timely But Flawed Review Steve Longworthbmj.com, 24 Aug 2001 [Full text]Steroids relieve pain in rotator cuff tendinopathy Simon Mellorbmj.com, 12 Sep 2001 [Full text]Steroids and trigger finger,. The correct site for injection. M Murnaghan, et al.

  4. Cochrane review (2003) • Corticosteroid injections for shoulder pain • may be of limited short-term benefit • Supports the use of subacromial steroid injection for rotator cuff disease • effect may be small and short-lived, and may be no better than NSAID’s • Intra-articular steroid injection • may be of limited, short-term benefit for adhesive capsulitis. Buchbinder et al. Corticosteroid injections for shoulder pain. Cochrane Database of Systematic Reviews 2003

  5. Cochrane review (2003) • Important issues that need clarification • Accuracy of needle placement • Anatomical site • Frequency • Dose • Type of steroid Buchbinder et al. Corticosteroid injections for shoulder pain. Cochrane Database of Systematic Reviews 2003

  6. Should I inject • “Missed the spot”

  7. J Shoulder Elbow Surg (2010) 19, 795-801

  8. My thoughts • Double edged sword • Reducing inflammation • Not good for tendon healing • Diagnostic ? • 1 Maybe 2 • Do No Harm • 2.5 ml syringe • Lignocaine • 40-80mg Depomedrone (Methyl prednisolone) • No touch • Nail mark • Ache 24 hrs • 6-8 weeks

  9. Injections about the shoulder • Subacromial space (bursa) • ACJ – Acromioclavicular joint • Bicipital groove (biceps tendon) • Intra articular

  10. Injections about the shoulder • Subacromial space (bursa) • Lateral • Postero lateral • ACJ – Acromioclavicular joint • Bicipital groove (biceps tendon) • Intra articular

  11. Injections about the shoulder • Subacromial space (bursa) • Lateral

  12. Subacromial space (bursa) • Lateral • Posterior • Posterior cuff • Field effect

  13. Subacromial space (bursa) • ACJ – Acromioclavicular joint • Bicipital groove (biceps tendon) • Intra articular

  14. ACJ

  15. VOL. 92-B, No. 5, MAY 2010

  16. Bicipital groove • Subacromial space (bursa) • ACJ – Acromioclavicular joint • Bicipital groove (biceps tendon) • Intra articular

  17. J SES (2011) 20, 1069-1073

  18. Intra articular • Subacromial space (bursa) • ACJ – Acromioclavicular joint • Bicipital groove (biceps tendon) • Intra articular • Anterior • Posterior • Nevaiser

  19. Anterior approach – 65% • Posterior approach – 45% • Neviaser approach – 45% • No difference in Experienced Vs Inexperienced Not statistically significant JSES (2011) 20, 1147-1154

  20. Anterior intra articular • Sitting up, arm neutral rotation • 21 gauge 2 inch needle • Just medial to humeral head • Directly below ACJ • 1cm superolateral coracoid • Direct posteriorly

  21. Posterior Intra articular • Patient sitting up right • 22 Gauge spinal needle • 2 cm inferior and 2 cm medial to posterolateral margin • Direct anteriorly to coracoid

  22. Neviaser intra articular • Sitting upright • 21 Gauge 2 inch needle • Palpate spine of scapula and follow to junction with posterolateral border of ACJ • Insert 1 finger breadth medial to this junction and angle 30-45° lateral and direct 15° anteriorly

  23. J Shoulder Elbow Surg (2010) 19, 795-801

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