Ultrasound-guided infiltration of the subacromial bursa of the shoulder

What is ultrasound-guided injection of the subacromial bursa of the shoulder?

Ultrasound-guided injection of the subacromial bursa of the shoulder is a treatment in which an anti-inflammatory medication is injected into the subacromiosubdeltoid bursa of the shoulder.

And what is a bursa?

Tendons, in some locations, are protected by mucous structures that interpose themselves between them and bone surfaces to prevent or reduce friction and premature deterioration. These structures are called bursae. Inflammation of these bursae can cause swelling, pain, and decreased joint function.
In the case of the rotator cuff tendons, the most relevant bursa for practical purposes and in daily clinical practice is the subacromiosubdeltoid bursa, or subacromial bursa.

What are the indications for ultrasound-guided injection of the subacromial bursa of the shoulder?

The main indications for ultrasound-guided injection of the subacromial bursa in the shoulder are:

• Subacromial bursitis: This is the most common indication. It is used to treat inflammation of the subacromial bursa that causes pain, especially when lifting the arm or sleeping on the affected shoulder.
• Subacromial impingement syndrome: This condition occurs when the rotator cuff tendons become trapped or pinched in the subacromial space. Injection can relieve associated pain and inflammation.
• Rotator cuff tendinopathy: In cases of rotator cuff pathology, such as tendinosis (tendon degeneration) or partial tears, injection of the bursa can help reduce the inflammation and pain that often accompany these injuries.
• Calcific tendonitis: In the treatment of calcific tendonitis, bursal injection with an anti-inflammatory agent after puncture and lavage of calcifications may be helpful in reducing post-procedure pain and inflammation.
• Diagnosis: In some cases, a local anesthetic injection into the bursa may be performed to confirm whether the source of shoulder pain is impingement or inflammation of the bursa. If the pain is significantly relieved after the injection, it is considered a positive diagnostic test.
• Frozen shoulder (adhesive capsulitis): Corticosteroid injection into the subacromial bursa may be a treatment option to improve pain and mobility in patients with frozen shoulder.

What is the procedure for ultrasound-guided injection of the subacromial bursa of the shoulder?

The ultrasound-guided injection of the subacromial bursa of the shoulder is usually performed in an outpatient setting and takes 10 to 15 minutes. Here is a summary of the procedure:

• Preparation: An ultrasound is performed prior to injection, with anatomical structures identified and the entry site marked on the skin.
• Local anesthesia: A small amount of local anesthetic is sometimes applied to the skin on the front of the hip to reduce pain during the injection.
• Asepsis: The skin is cleaned with antiseptic, and the equipment and the dressing are prepared under strict aseptic conditions.
• Ultrasound guidance: Ultrasound is used to guide the needle into the subacromial bursa of the shoulder and ensure the medication is administered in the correct location.
• Drug injection: The medication is administered through the needle and into the subacromial bursa of the shoulder.

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