Joint Steroid Injection

Joint Injection Procedure Note

Date: ***
Time: ***
Indication: “Pain with joint movement”
Resident: ***
Attending : *** was available during the procedure

The ***Sub-acromial joint was marked and then prepped in the usual sterile fashion. Using a 25 gauge 3.5 inch needle, *** ml of lidocaine and  *** ml of Triamcinolone were injected without difficulty. After injection, the joint was passively moved through the full range of motion and a sterile dressing was applied. The patient tolerated the procedure well. Aftercare was discussed.

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General Indications:

Chronic joint pain (due to rotator cuff tear, ligament tear, osteoarthritis…)
Impingement (to break the cycle of joint dysfunction -> impingement -> more dysfunction -> more impingement)
Bursitis

Medications used:

Triamcinolone (Kenalog 40mg/1ml)
– Alternatives: Betamethasone (Celestone Soluspan 6mg/ml) or Methylprednisolone (Depo-Medrol 40mg/1ml vial)
Lidocaine (Xylocaine 1% 10mg/ml)
– Alternatives: Bupivacaine (Marcaine 0.5% 5mg/ml)

Locations of joint injections: 

Shoulder:
Sub-acromial bursa
Acromioclavicular joint
Gelnohumeral joint
Sheath of long head of biceps

Sub-acromial Injection: 

Indication:
Tendon Impingement
Rotator cuff tears Patient population:
Excessive use of shoulder joint: patient with stroke, MS, patients in wheelchairs who must use their arms to get out of chairs and to propel the wheelchairs. Dose:
Kenalog 20-40mg (0.5-1 ml) + Xylocaine 20mg (2ml) Landmark:
1cm below and medial to the posterior angle of the acromion process.

Technique:

• Patient should be setting up with arms adducted (so weight of the arm will open the joint space)
• Physician will be standing behind the patient, have the medications prepared in a 25G 3.5cm needle.
• Palpate the spine of scapula and go laterally along the spine till you reach the posterior corner of the acromion. Slide your finger 1 cm below and medial to the posterior corner of acromion, you will feel a gap between the bony structures filled with soft tissue, the sub-acromial bursa. With needle facing antero lateral, insert the whole 3 cm needle and inject the medications.

Video: https://www.youtube.com/watch?v=YXtQQAd4n1E