Injecting the acromioclavicular joint
Our new series on joint injection techniques kicks off with a look at the acromioclavicular joint to help you fine tune your injection technique.
Osteoarthritis of the acromioclavicular joint is a common cause of pain in patients aged over 50. Patients present with pain directly over the joint, and the diagnosis is confirmed on examination.
• There may be an osteophyte palpable over the joint space.
• Abduction of the arm from horizontal to vertical will produce pain over the acromioclavicular joint.
• Forcefully adducting the arm across the front of the chest under the chin with the forearm flexed at 90° while protracting the shoulder girdle causes pain over the acromioclavicular joint.
• Forcefully adducting the arm posteriorly across the back of the chest produces pain at the limit of adduction.
A diagnostic injection of local anaesthetic will relieve pain. Injection with steroids does not alter the disease progression, but is valuable for longer-term relief.1
The acromioclavicular joint has a very small joint space that will only accept an injection of between 0.2ml and 0.5ml of fluid. Use a 2ml volume syringe with a 1.6cm needle. It is not necessary to mix local anaesthetic and inject up to 0.5ml of triamcinolone acetonide.
Carefully palpate the joint space and insert the needle either superiorly with a vertical approach or anteriorly, ensuring that only the tip of the needle enters the joint space. Although the joint space is sometimes difficult to enter because of the presence of an osteophyte, it is equally easy to push the needle too far and enter the shoulder capsule from above.
Rotator cuff tendinitis and frozen shoulder
Subacromial steroid injections are more effective in terms of symptom improvement compared with NSAIDs for rotator cuff tendinitis and frozen shoulder. The effect lasts for nine months. A cost consequences analysis of local steroid shoulder injection and physiotherapy for new episodes of shoulder pain in primary care reported similar clinical outcomes for both treatment groups, and that steroid injections were the more cost-effective option.2
- Buttaci CJ, Stitik TP, Yonclas PP and Foye PM. Osteoarthritis of the acromioclavicular joint: a review of anatomy, biomechanics, diagnosis and treatment.Am J Phys Med Rehabil 2004;83:791-7
- James M, Stokes EA, Thomas E et al. A cost analysis of local steroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care. Rheumatol 2005;44:1447-51
This extract is taken from Joint and Soft Tissue Injection 5th Edition, by Dr Trevor Silver which is now available to purchase from Radcliffe Publishing with an exclusive 20% discount available until 30th September – simply quote PULSETS12.
- Confidently diagnose conditions of the joints and soft tissue.
- Understand the benefits and pitfalls of steroid injections.
- New content – sports physiotherapy, elbow joint, iliotibial band syndrome and updates on greater trochanter pain syndrome.
This book has been adapted into an interactive app, bringing to life the high-quality illustrations and diagrams. It allows you to effortlessly navigate through the detailed explanations of technique.