From the Research
The best approach for a shoulder injection to treat subacromial bursitis is the posterolateral approach with a high-volume injection of a corticosteroid, such as triamcinolone 40mg, combined with 9-10ml of 1% lidocaine, as it provides reliable access to the subacromial space with minimal risk to surrounding structures and has been shown to be effective in reducing inflammation and pain. The procedure should be performed with the patient seated and the arm relaxed at their side. After identifying anatomical landmarks, such as the posterolateral corner of the acromion, the area should be sterilized and the needle (typically 22-25 gauge, 1.5 inch) inserted at a 45-degree angle, directed toward the anterior acromion. Aspiration should be attempted first to rule out infection or confirm effusion. The injection should feel minimal resistance, and the medication should be delivered smoothly into the bursal space. Post-injection, patients should rest the shoulder for 24-48 hours, apply ice for pain, and gradually return to normal activities over 3-5 days. This approach is supported by a study published in the European Journal of Radiology in 2020, which found that high-volume injections yielded higher chances of early pain recovery compared to low-volume injections 1. Additionally, a study published in Clinical Rehabilitation in 2021 found that corticosteroid injection was effective and superior to hyaluronic acid and normal saline injection for treating chronic subacromial bursitis 2. It is also worth noting that the use of ultrasound guidance can improve the accuracy and safety of the injection, as demonstrated in a study published in Modern Rheumatology in 2009 3. Overall, the posterolateral approach with a high-volume injection of a corticosteroid and local anesthetic is a safe and effective treatment for subacromial bursitis.
Some key points to consider when performing a shoulder injection for subacromial bursitis include:
- Using a high-volume injection to increase the chances of early pain recovery
- Combining a corticosteroid with a local anesthetic to provide both anti-inflammatory and pain-relieving effects
- Using ultrasound guidance to improve the accuracy and safety of the injection
- Having the patient rest the shoulder for 24-48 hours after the injection and gradually return to normal activities over 3-5 days.
It is also important to note that the effectiveness of the injection can depend on various factors, such as the severity of the condition, the patient's overall health, and the technique used for the injection. Therefore, it is essential to carefully evaluate each patient and adjust the treatment plan accordingly. In some cases, repeated injections may be necessary to achieve optimal results, as demonstrated in a study published in Annals of Rehabilitation Medicine in 2014 4. However, the decision to repeat the injection should be made on a case-by-case basis, taking into account the patient's response to the initial treatment and any potential risks or side effects.
In terms of the specific corticosteroid to use, triamcinolone 40mg has been shown to be effective in reducing inflammation and pain in patients with subacromial bursitis, as demonstrated in a study published in Joint Bone Spine in 2015 5. However, other corticosteroids, such as methylprednisolone, may also be effective, as demonstrated in a study published in Modern Rheumatology in 2009 3. Ultimately, the choice of corticosteroid will depend on the individual patient's needs and the clinician's preference.
Overall, the posterolateral approach with a high-volume injection of a corticosteroid and local anesthetic is a safe and effective treatment for subacromial bursitis, and can be tailored to meet the individual needs of each patient.