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<br /> Ultrasound<br /> Ultrasound-guided shoulder<br /> joint and bursa injections<br /> Philips tutorial<br /> Samer Narouze, MD, PhD, FIPP<br /> Clinical Professor of Anesthesiology and Pain Medicine, OUCOM<br /> Clinical Professor of Neurological Surgery, OSU<br /> Associate Professor of Surgery, NEOUCOM<br /> Chairman, Center for Pain Medicine<br /> Summa Western Reserve Hospital, Cuyahoga Falls, OH<br /> Contents<br /> Ultrasound-guided shoulder joint and bursa injections<br /> 1 Introduction 3<br /> 2 Clinical anatomy 4<br /> 3 Glenohumeral joint (GHJ) injections 12<br /> 4 Subacromial and subdeltoid<br /> bursa (SASDB) injections 31<br /> 5 Acromioclavicular joint (ACJ)<br /> injections 41<br /> 6 References 47<br /> Additional resources <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 1" href="http://viewer.zmags.com/publication/b845b56b?page=1"> Ultrasound Ultrasound-guided shoulder joint and </a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 2" href="http://viewer.zmags.com/publication/b845b56b?page=2"> Contents Ultrasound-guided shoulder joint and bu</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 3" href="http://viewer.zmags.com/publication/b845b56b?page=3"> 1 Introduction Shoulder pain disorders ar</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 4" href="http://viewer.zmags.com/publication/b845b56b?page=4"> 2 Clinical anatomy Anatomy of the shoulder g</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 5" href="http://viewer.zmags.com/publication/b845b56b?page=5"> Innervations and blood supply • The GHJ is innerv</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 6" href="http://viewer.zmags.com/publication/b845b56b?page=6"> Rotator cuff The rotator cuff is a tight layer of</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 7" href="http://viewer.zmags.com/publication/b845b56b?page=7"> Bursae The subacromial and subdeltoid bursa (SASD</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 8" href="http://viewer.zmags.com/publication/b845b56b?page=8"> Rotator cuff interval The rotator cuff interval (</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 9" href="http://viewer.zmags.com/publication/b845b56b?page=9"> The RCI contains the tendon of the long head of t</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 10" href="http://viewer.zmags.com/publication/b845b56b?page=10"> Acromioclavicular joint anatomy The acromioclavic</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 11" href="http://viewer.zmags.com/publication/b845b56b?page=11"> © 2015 Koninklijke Philips N.V. All rights are re</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 12" href="http://viewer.zmags.com/publication/b845b56b?page=12"> 3 Glenohumeral joint (GHJ) injections In</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 13" href="http://viewer.zmags.com/publication/b845b56b?page=13"> Advantages of different approaches Posterior appr</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 14" href="http://viewer.zmags.com/publication/b845b56b?page=14"> Sonoanatomy and GHJ injection techniques Posterio</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 15" href="http://viewer.zmags.com/publication/b845b56b?page=15"> [Figure 4a] Transducer and needle orientation for</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 16" href="http://viewer.zmags.com/publication/b845b56b?page=16"> © 2015 Koninklijke Philips N.V. All rights are re</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 17" href="http://viewer.zmags.com/publication/b845b56b?page=17"> [Figure 4c] Ultrasound image showing the posterio</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 18" href="http://viewer.zmags.com/publication/b845b56b?page=18"> [ Video 1 ] Video dem</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 19" href="http://viewer.zmags.com/publication/b845b56b?page=19"> Rotator cuff interval approach The patient is pla</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 20" href="http://viewer.zmags.com/publication/b845b56b?page=20"> On the ultrasound image note that the lesser tube</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 21" href="http://viewer.zmags.com/publication/b845b56b?page=21"> In the bicipital groove, the tendon is invested b</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 22" href="http://viewer.zmags.com/publication/b845b56b?page=22"> [Figure 6b] Ultrasound image demonstrating an eff</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 23" href="http://viewer.zmags.com/publication/b845b56b?page=23"> [Figure 6c] Ultrasound image of GHJ post-drainage</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 24" href="http://viewer.zmags.com/publication/b845b56b?page=24"> [ Video 2 ] Ultrasoun</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 25" href="http://viewer.zmags.com/publication/b845b56b?page=25"> The LHB tendon runs a superomedial course from th</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 26" href="http://viewer.zmags.com/publication/b845b56b?page=26"> [Figure 7a] Transducer and needle orientation for</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 27" href="http://viewer.zmags.com/publication/b845b56b?page=27"> [Figure 7b] Transducer and needle orientation for</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 28" href="http://viewer.zmags.com/publication/b845b56b?page=28"> © 2015 Koninklijke Philips N.V. All rights are re</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 29" href="http://viewer.zmags.com/publication/b845b56b?page=29"> [ Video 3 ] Ultrasoun</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 30" href="http://viewer.zmags.com/publication/b845b56b?page=30"> [Figure 8] Ultrasound image of the rotator cuff i</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 31" href="http://viewer.zmags.com/publication/b845b56b?page=31"> 4 Subacromial and subdeltoid bursa (SASDB)</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 32" href="http://viewer.zmags.com/publication/b845b56b?page=32"> The need for ultrasound (US) guidance • The accur</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 33" href="http://viewer.zmags.com/publication/b845b56b?page=33"> Supraspinatus tendon sonoanatomy and subacromial </a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 34" href="http://viewer.zmags.com/publication/b845b56b?page=34"> Subacromial impingement can be assessed dynamical</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 35" href="http://viewer.zmags.com/publication/b845b56b?page=35"> [ Video 4 ] Subacromi</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 36" href="http://viewer.zmags.com/publication/b845b56b?page=36"> Sonoanatomy and SASDB injection technique To bett</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 37" href="http://viewer.zmags.com/publication/b845b56b?page=37"> The diagnosis of impingement or the so-called “im</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 38" href="http://viewer.zmags.com/publication/b845b56b?page=38"> [Figure 10a] Patient in the Crass position. </a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 39" href="http://viewer.zmags.com/publication/b845b56b?page=39"> [Figure 10b] Transducer and needle orientation fo</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 40" href="http://viewer.zmags.com/publication/b845b56b?page=40"> [Figure 10c] Ultrasound image of the SASDB (arrow</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 41" href="http://viewer.zmags.com/publication/b845b56b?page=41"> 5 Acromioclavicular joint (ACJ) injection</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 42" href="http://viewer.zmags.com/publication/b845b56b?page=42"> Sonoanatomy and ACJ injection technique The joint</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 43" href="http://viewer.zmags.com/publication/b845b56b?page=43"> Either out-of-plane or in-plane needle technique </a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 44" href="http://viewer.zmags.com/publication/b845b56b?page=44"> Acromion Supraspinatus © 2015 Ko</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 45" href="http://viewer.zmags.com/publication/b845b56b?page=45"> [Figure 11b] Transducer orientation for ACJ injec</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 46" href="http://viewer.zmags.com/publication/b845b56b?page=46"> [Figure 12] Sonogram showing the ACJ (*) as a hyp</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 47" href="http://viewer.zmags.com/publication/b845b56b?page=47"> 6 References 1. Burbank KM, Stevenson JH</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 48" href="http://viewer.zmags.com/publication/b845b56b?page=48"> 18. Naredo E, Cabero F, Beneyto P, et al. A rand</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 49" href="http://viewer.zmags.com/publication/b845b56b?page=49"> Additional resources For additional resources</a> <a title="UltrasoundGuidedShoulder_injectionsTutorial_Zmag page 50" href="http://viewer.zmags.com/publication/b845b56b?page=50"> This paper reflects the opinion of the author, no</a>