Ultrasound guided shoulder injections

Ultrasound guided shoulder injections are some of the most popular procedures referred for and performed. Ultrasound guided shoulder injections are often best performed as part of a comprehensive package of treatment including other approaches. They do however have a role to play for some patients , and some conditions, and we have therefore outlined some of the key techniques which we utilise in our practice. We elaborate on these approaches on our training courses, and through discussions on our social media channels.

Subacromial subdeltoid bursa injection – transverse approach

This technique is similar in its approach to the ‘landmark’ guided approach, but more anterior and not deep to the Acromion process. It is a technique that allows good needle visualisation from the start, and is often comfortable for the patient. If the patient is able to extend the shoulder slightly, it facilitates the humeral head and the greater tuberosity forwards leading to more of the humeral head being exposed, and more of the bursa being visible. Always try and target an area where the bursa is slightly distended to make things easier.

Free access guided injection articles relating to the subacromial subdeltoid bursa.

Articles chosen due to availability in free, full text format on-line.

Ekeberg, Ole M., et al. "Subacromial ultrasound guided or systemic steroid injection for rotator cuff disease: randomised double blind study." Bmj 338 (2009): a3112.

Molini, L., S. Mariacher, and S. Bianchi. "US guided corticosteroid injection into the subacromial-subdeltoid bursa: technique and approach." Journal of ultrasound 15.1 (2012): 61-68.

Rutten, Matthieu JCM, et al. "Injection of the subacromial-subdeltoid bursa: blind or ultrasound-guided?." Acta orthopaedica78.2 (2007): 254-257.

Sage, William, et al. "The clinical and functional outcomes of ultrasound-guided vs landmark-guided injections for adults with shoulder pathology—a systematic review and meta-analysis." Rheumatology 52.4 (2012): 743-751.

Subacromial subdeltoid bursa (transverse approach) ultrasound guided injection technique

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Ultrasound guided injection training courses

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Acromioclavicular joint injection

This is often a technique that appears straightforward but can be deceptively difficult, highlighted by the poor accuracy rates highlighted in research with regards to landmark guided approaches. The capsule of the joint can sometimes be very thick and difficult to inject into, particularly in degenerative conditions. The lateral approach is the standard approach performed, and can be facilitated by the use of sterile gel to help guide the needle if the shoulder is very slim. Other approaches included a posterior approach, and we cover this on some of our training courses.

Acromioclavicular joint - ultrasound guided injection technique

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Free access guided injection articles relating to the acromioclavicular joint

Articles chosen due to availability in free, full text format on-line.

Park, K. D., et al. "Palpation Versus Ultrasound-Guided Acromioclavicular Joint Intra-articular Corticosteroid Injections: A Retrospective Comparative Clinical Study." Pain physician 18.4 (2014): 333-341.

Wasserman et al (2013) Accuracy of Acromioclavicular Joint Injections, The American Journal of Sports Medicine.

Javed et al (2017) Should all acromioclavicular joint injections be performed under image guidance?Journal of Orthopaedic surgery.

Cadogan et al (2013) Shoulder pain in primary care: diagnostic accuracy of clinical examination tests for non-traumatic acromioclavicular joint pain, BMS musculoskeletal disorders.

Glenohumeral joint injection – posterior medial to lateral approach

We would recommend this technique as a starting point to performing ultrasound guided glenohumeral joint injections. The technique can be performed with the patient in sitting (and the arm horizontally adducted) or in lying. It particularly lends itself to situations where there may be a joint effusion within the posterior recess, for example in degenerative joint conditions. Taking care to avoid the posterior labrum, and ensuring that the needle chosen is long enough to reach the target – it can be deceptively deep!

ultrasound guided injection of the shoulder

Glenohumeral joint injection (posterior -medial to lateral approach) ultrasound guided injection techniquedownload

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Glenohumeral joint injection – anterolateral approach

This is a technically more demanding approach to the shoulder, and we would only recommend using this technique once you have mastered needle visualisation and obtaining the correct angles of entry. This technique lends itself to patients where there is not an effusion, and also has an advantage in that there is less depth prior to reaching the target. It can be challenging to always clearly visualise the entire needle with this technique.