Presentation
Long standing shoulder pain. Worse with activity.
Patient Data
Image 1 and 2 show the supraspinatus is severely thickened with heterogenous echogenicity, indicating severe tendinopathy. The subacromial subdeltoid (SASD) bursa is mildly thickened.
In image 3, a 25G needle extends from the left of the image with its tip in the SASD bursa which is partly distended from the injectate.
The post-injection video shows the SASD bursa is markedly distended. The small foci of high echogenicity within the superior aspect of the distended bursa are small bubbles of iatrogenic gas.
Case Discussion
Subacromial subdeltoid (SASD) bursa injections are frequently performed for shoulder pain. US-guidance ensures the injectate is delivered into the targeted SASD bursa.
The SASD bursa is large and extends over all of the tendons of the rotator cuff and a larger volume of injectate ensures adequate dispersion of the injectate and also aiding breakdown any adhesional tissue within the SASD bursa.
A 25G needle was used in this case and 10mL of injectate given into the bursa - 40mg triamcinolone (40mg/1mL), 4mL 0.5% ropivacaine and 5mL 1mL lidocaine.