My Typical Injection

• 5 mL syringe

• 22 gauge, 1 5/8 inch needle

• 4 mL 1% lidocaine without epinephrine

• 1 mL (40mg) Kenalog (triamcinolone)

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Subacromial Approach

1. Obtain and document, at least, verbal consent for procedure

2. Have patient seated with hands resting in his/her lap, and shoulders relaxed

3. Palpate the shoulder landmarks and identify the posterior lateral border of the acromion.  Just below that a soft spot between the acromion and humeral head should be easily palpated.  This is the subacromial space, and is the injection site.

4. Mark with a surgical skin marker

5. Apply gloves

6. Apply topical antiseptic 

7. Apply analgesic, if desired (I use ethyl chloride)

8. Slowly and controlled, insert needle, through the marked entry point, in the plane of the scapula

9. Inject slowly

10. Withdraw needle

11. Wipe clean

12. Apply bandage

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My Typical Injection

• 5 mL syringe

• 22 gauge, 1 5/8 inch needle

• 4 mL 1% lidocaine without epinephrine

• 1 mL (40mg) Kenalog (triamcinolone)

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Posterior Intra-articular Approach

1. Obtain and document, at least, verbal consent for procedure

2. Have patient seated with hands resting in his/her lap, and shoulders relaxed

3. Palpate the shoulder landmarks and identify the posterior lateral corner of the acromion.  Two finger breadths distal and one finger breadth medial to the posterior lateral acromion is a soft spot. This is the injection site.

4. Mark with a surgical skin marker

5. Palpate coracoid process, anteriorly.  This is your aiming point for the trajectory of the needle insertion.

6. Apply gloves

7. Apply topical antiseptic x 3 at the injection site

8. Apply analgesic, if desired (I use ethyl chloride)

9. Slowly and controlled, insert needle, through the marked entry point, posterior to anterior, aiming for the coracoid

10. Inject slowly

11. Withdraw needle

12. Wipe clean

13. Apply bandage

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My Typical Injection

• 3 or 5 mL syringe

• 25 gauge, 1/2 inch needle

• 1 mL 1% lidocaine without epinephrine

• 1 mL (6mg) Celestone

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Acromioclavicular Joint Injection

1. Obtain and document, at least, verbal consent for procedure

2. Have patient seated with hands resting in his/her lap, and shoulders relaxed

3. Palpate the shoulder acromion and distal clavicle.  A slight dip into a narrow space can usually be palpated off the distal end of the clavicle.  This is the AC joint and the injection site.

4. Mark with a surgical skin marker

5. Apply gloves

6. Apply topical antiseptic x 3 at the injection site

7. Apply analgesic, if desired (I use ethyl chloride)

8. Slowly and controlled, insert needle, through the marked entry point, posterior to anterior, aiming for the coracoid

9. Inject slowly

10. Withdraw needle

11. Wipe clean

12. Apply bandage

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