Ultrasound-guided shoulder joint injections

Subacromial bursa (SAB) and glenohumeral joint (GHJ) injections are commonly performed for shoulder pain and dysfunction. For patients with rotator cuff or impingement syndromes, the SAB injection may provide temporary relief of pain and increase shoulder mobility, as well as help confirm the diagnosis. Likewise, for patients with calcific tendonitis or arthritis of the GHJ, injection of the GHJ may be therapeutic.Although these procedures are usually performed “blindly” without image guidance, inadvertent extra-articular injections have been frequently reported; therefore, many practitioners use fluoroscopy for confirmation of proper needle placement. Avoiding the problems associated with radiation, ultrasound (US) guidance offers an alternative, real-time imaging modality that can also ensure accurate needle placement.This paper presents techniques of SAB and GHJ injections that are suitable for US guidance. A posterolateral approach targeting the SAB between the acromion and the greater tuberosity of the humerus will be introduced, as the authors find this approach simple and effective. For the GHJ, a traditional posterior approach and an alternative rotator interval approach will be described. With proper training, clinicians should be able to incorporate US-guided joint injections into their practice.