musculoskeletal and connective tissue disorders
How To Inject a Subacromial Bursa
Step by Step Description of Injecting a Subacromial Bursa
Mark the needle entry site on the skin. Prepare the area with antiseptic solution. Spray freezing spray at the needle insertion site until it just blanches and/or inject a skin wheal of local anesthetic (≤ 1 mL). Wear gloves. Lateral needle insertion approach: Insert the needle below the lateral acromion border and above the humeral head. Posterior needle insertion approach: Insert the needle 2 to 3 cm inferior to the posterolateral corner of the acromion and direct it anteriorly toward the coracoid process, aiming upward at a 10° angle. If the needle encounters the acromion,retract the needle about 1 mm. Gently pull back on the plunger prior to injection to rule out intravascular placement. Slowly inject the anesthetic/corticosteroid mixture and withdraw the needle. If the injection meets resistance,the needle tip may be within the supraspinatus tendon. Stop injecting, partially withdraw the needle, and then readvance it more superiorly until the injection does not meet resistance. Pain is immediately relieved after a properly placed injection of anesthetic. Apply an adhesive bandage or sterile dressing. 