Subacromial Bursa Injection
Evidence Grade B: For the temporary recution of pain compared to placebo.
Obtain informed consent from the patient.
Gather appropriate materials needed for the procedure.
First, draw up 5cc of 1-2% lidocaine into a 10cc syringe.
Then draw up steroid into the same syringe in order to intermix the two together. You may use this list of four commonly used steroids as a reference.
Place your patient in a seated position on the exam table (hands resting in the lap).
In this image: Preparing for the subacromial bursa injection.
Think about which anatomic landmarks you can use to locate the subacromial bursa. Where is the bursa located?
Apply gentle downward traction on the patient's humerus and palpate the lateral and posterior edges of the acromion.
Palpate the soft indentation just inferior to the acromion with your thumb to locate the subacromial bursa and mark with skin marker (optional).
Cleanse the skin over subacromial bursa with povidone-iodone or alcohol.
You may use ethyl chloride spray on the skin just prior to injection for anesthesia (optional).
Advance a 21- to 25-gauge, 1.5-inch needle attached to the syringe perpendicular to the skin at the previously identified space, with your needle directed towards the patient's sternal notch.
Keep gently advancing the needle until you appreciate subtle resistance, followed by a sensation of "giving way." This is the penetration of the deltoid muscle fascia and entrance into the subacromial bursa.
In this image: The physician inserts the needle.
Inject the lidocaine/steroid mixture into the space.
Does it flow easily? There should be very little resistance if the needle is correctly inserted into the bursa.
Is there high resistance or grittiness? The needle may be in the supraspinatus tendon just under and medial to the subacromial bursa. Pull the needle back slightly and redirect until the medication flows freely.
To complete the procedure:
Withdraw the needle upon completion of the injection.
Apply gentle pressure to the injection site with sterile gauze. Cover the area with a small bandage.
Re-examine the patient's shoulder.
Has their pain improved?
Is there increased range of motion and/or strength than before the injection? If so, subacromial impingement or bursitis was likely the cause of the patient's symptoms (and less likely a rotator cuff tear).