Name:
Subacromial Injection for Shoulder Impingement
Description:
Subacromial Injection for Shoulder Impingement
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Duration:
T00H05M57S
Embed URL:
https://stream.cadmore.media/player/2c6ee2f8-91f3-4d26-aefa-bf6ee3c297d4
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/2c6ee2f8-91f3-4d26-aefa-bf6ee3c297d4/Subacromial Injection for Shoulder Impingement.mp4?sv=2019-02-02&sr=c&sig=q0uEuef7UxSEWlYyZe3UxULo5ZH6%2BnZJz4b0%2BgM6e7g%3D&st=2024-11-21T13%3A46%3A24Z&se=2024-11-21T15%3A51%3A24Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Well today, I'm going to demonstrate you a technique in which we are going to inject a steroid injection in the subacromial space in gentlemen's shoulder for a supraspinatus impingement. Now, supraspinatus impingement is a very common cause of shoulder pain and your clinical practice, you will be required to do this injections. So I'm going to take you by step by step as how to do these injections properly.
So in order to do this injection, you need to be aware of certain landmarks. So I've drawn that for you. If you feel this is the superior border of the clavicle, this is inferior to the clavicle field for the coracoid that is right in the front here. Then you feel for the anterior and posterior aspect of the acromion. So this is the a this is the posterior aspect.
This is anterior aspect. This is the lateral border of the acromion, which I have drawn. Now this is the spinous process. And this is the shoulder. Now there are two approaches that we commonly use, one is the posterior approach that we go from the back, and the other approach is the lateral approach where we go from the lateral aspect.
So let me talk about the posterior approach first, because that is what I commonly use. So I will demonstrate to you how to do the posterior approach first. So for doing the posterior approach, if you've seen doing shoulder arthroscopy, we talk about a soft spot. Now the soft spot is just a centimeter below this posterolateral border of the acromion.
So feel for the acromion, feel for the spinous process. This is the postural little corner. If I draw it here and if it's just below it, you will feel the soft spot. So this is where which will be the site of injection. So if I can just put a pointer here roughly a centimeter below. And inferior to the positive order of the spinous process.
Now the direction is also important. The reason we draw the coracoid in the front coracoid is right here. Now your needle has to be direct it in direction of the coracoid. You can't. You don't go straight. You don't go lateral. So you aim your needle going towards the coracoid in this direction.
So this is how you do the lateral. This is how we do the posterior approach. Now, if we talk about the lateral approach, if you divide the acromion into three parts. You will do this injection from the posterior end of the most posterior part, and the reason is if you can see. The shoulder here, the space here is very little. So if you go directly here, you will struggle because the space here is really tight because humeral head is there.
Now if you see here, the space is still slightly open. And when you're doing the lateral approach you instead of a centimeter, you go slightly more than roughly a couple of centimeters down roughly here. And then you are aiming. It's the center of the economy, and if we divide it into two, if you aim in this direction, if you go your needle in this direction, that will be the appropriate direction.
If you stay too close, then you will struggle to find the space. My preferred approach is posterior approach because that's what I'm trained for. But if you want to use lateral approach, many studies have shown it to be superior than the posterior approach. So in terms of mixture, what I give my cocktail contains of 40 milligrams of Depo mitron, so roughly a mil of depo, mitron and I take around three to four Mils of 1% or 2% lidocaine.
Now this part is already cleared or cleaned with alcoholic solutions, so this is all sterile. Now, the technique for injection is pretty easy. Just I just give it a shake because I have prepared it for a long period of time. So just aiming in the soft spot, remembering where my coracoid is, so my coracoid is here. So if you want, you can give local anesthetic. I don't because I find if you prick the skin, you give pain.
And if your technique is good, you don't need to give local anesthetic injection. So just underneath that soft spot, aiming towards the acromion and just underneath. So the patient does feel some discomfort, but usually not. If you are in the right space, this should go very, very easily, so you can see it's flowing really easily. And if you can see my direction, it's aiming towards the coracoid, so I don't know if you can just move your camera and just show the direction, it's slightly at an angle, it's not directly in the front.
So this is the injection done for. So monitors impingement. True posterior approach. So in the same patient, if I had to do the lateral approach, I've just taken the needle off, I just want to demonstrate I will be coming a couple of centimeters down and I will be aiming up towards the center of the acromion. This is what the direction will be.
So once the injection is done, you just put a small, sterile dressing and that's your AM injection done for supraspinatus impingement through posterior approach. Well, the technique of doing subacromial injection for supraspinatus impingement to posterior approach have also demonstrated if you choose to do lateral approach how to do a lateral approach, this is extremely easy and the patient does feel some discomfort, but it's almost pain free.
I hope you like this. Video if you like this video, give us a thumbs up. Do subscribe and to share our channel. Thank you.
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