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Subacromial bursal injection

Dr Jeremy Jones ◉ and Dr Alborz Jahangiri et al.

Subacromial corticosteroid injection is reserved for patients with no response to initial treatment with impingement syndrome, subacromial bursitis and/or rotator cuff disorders. Nonsteroidal anti-inflammatory drugs (NSAIDs) and activity modification are the initial treatments to reduce the pain and inflammation.

On this page:

Article:

Indications
Contraindications
Procedure
Complications
Outcomes
Related articles
References

Images:

Cases and figures

Indications

symptomatic subacromial impingement syndrome
rotator cuff disorder
adhesive capsulitis

Contraindications

Infection/cellulitis of the overlying skin, osteomyelitis of the adjacent bone and bacteremia are absolute contraindications.

Allergic reaction to disinfectants and local anesthetics, more than 3-4 corticosteroid injections per patient per year, poorly controlled diabetes, coagulopathy and glaucoma are relative contraindications.

Procedure

The skin is disinfected. Sterile gloves are worn, and a 21-27 gauge needle is used to penetrate the skin parallel or oblique concerning the surface of the probe and 2 cm away from the probe. The needles progress is monitored in real time with ultrasonographic guidance, and the injection is performed when the tip appears to be inside the bursa. Hypoechoic fluid can be seen spreading inside the bursa while injecting. The thinner the needle, the more difficult it is to identify the needle and to perform the injection.

A dose of corticosteroid (0.5 mL of dexamethasone 4 mg/mL) with local anesthetic (1-1.5 mL of bupivacaine 0.5%) can be used for analgesic effect.

Preprocedural evaluation

review contraindications
review previous images
perform complete ultrasound study of the affected shoulder to confirm a diagnosis
informed consent

Positioning/room set up

US guided corticosteroid injections into the subacromial-subdeltoid bursal space are carried out with the patient sitting on a chair with the patient's back turned to the doctor. Lateral approach is the most frequently used approach in which the long axis of the supraspinatus is parallel to the probe. The appropriate position of the shoulder is identified with ultrasound (the thickest part of the bursa or the area with more fluid accumulation in the bursa), the patient is asked to stay still and keep the position.

Equipment

sterile gauze
sterile gloves
skin disinfectant
21 to 27 gauge long needles
local anesthetic: 1-1.5 mL of bupivacaine 0.5%
corticosteroids: 0.5 mL of dexamethasone 4 mg/mL

Technique

Lateral approach is the most frequently used approach in which the long axis of the supraspinatus is parallel to the probe, and the needle is inserted parallel or oblique in relation to the probe and 2 cm away from the probe to avoid the sterile needle contact with the probe.

Postprocedural care

Avoidance of shoulder overuse for 2-3 days is recommended to the patients.

Symptoms suggesting infection and the possibility of pain and rash at the site of the injection are explained to patients.

Complications

Infection is the most common complication. Vasovagal reaction within 5-10 minutes post procedure, flushing of the skin within 2-3 days after the injection are the side effects of corticosteroid injection.

Outcomes

Subacromial-subdeltoid bursal injection is a straightforward and well-tolerated procedure by the patients. Corticosteroid can be injected into the appropriate space confidently under ultrasonographic guidance, and vascular, neural and tendons are avoided with certainty during the procedure.

References

Interventional procedures

introduction
- procedure overview
breast
chest
- thoracic biopsy (CT-guided)
- thoracentesis (pleural tap)
gastrointestinal
- stomach
  - percutaneous endoscopic gastrostomy (PEG)
hepatobiliary
- liver
- biliary system
neck
- thyroid gland
  - thyroid gland FNA
musculoskeletal
- bone biopsy (CT-guided)
- shoulder (disambiguation)
  - acromioclavicular joint injection
  - glenohumeral joint injection
    - glenohumeral (shoulder) arthrography
    - glenohumeral (shoulder) hydrodilatation
  - long head of biceps tendon sheath injection
  - subacromial bursal injection
spine
- spinal interventional procedures (general)
urogenital
- bladder
  - cystolithotomy
- kidney
- prostate
  - prostate biopsy
  - transurethral resection of the prostate (TURP)
vascular
- venous
  - intravenous cannulation (ultrasound-guided)
  - inferior vena cava filter

Article information

rID: 46659

System: Musculoskeletal, Interventional

Section: Interventional Radiology

Tag: procedure, cases

Synonyms or Alternate Spellings:

SAB injection
Subacromial bursal injections
SAB injections

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Cases and figures

Case 1: subacromial bursal injection Case 1: subacromial bursal injection

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