What is the procedure for a glenohumeral (shoulder) joint injection?

From the Guidelines

The procedure for a glenohumeral (shoulder) joint injection should always utilize a sterile, single-use, disposable needle and syringe for each injection given, as emphasized by the importance of infection prevention 1.

Key Considerations

• The injection typically contains a corticosteroid combined with a local anesthetic.
• The procedure can be performed using anatomical landmarks or with image guidance for greater accuracy.
• Patients should be informed about potential side effects including temporary pain flare, skin discoloration, infection, and tendon weakening with repeated injections.

Procedure Details

• The anterior approach is most common, with the needle inserted just lateral to the coracoid process and directed posteriorly toward the glenohumeral joint.
• Aseptic technique should always be undertaken when performing the injection, including the use of surgical gloves, skin preparation with alcohol, iodine disinfectant, or chlorhexidine, and changing needles between drawing the drug and injecting it into the joint 1.
• Local anesthetics may be offered to reduce discomfort during the procedure and to extend pain reduction effect.

Post-Procedure Care

• Patients should avoid overuse of the injected joint for 24 hours following the injection, but immobilization is discouraged 1.
• Relief typically begins within 2-3 days and may last weeks to months.
• Following the injection, patients should rest the shoulder for 24-48 hours and gradually return to normal activities.

Important Considerations for Specific Patient Groups

• Diabetic patients should be informed about the risk of transient increased glycaemia following intra-articular glucocorticoid injection and advised about the need to monitor glucose levels particularly from the first to third day 1.
• The decision to reinject a joint should take into consideration benefits from previous injections and other individualized factors, with a general accepted rule to avoid more than 3-4 glucocorticoid injections in the same joint per year 1.

From the Research

Procedure for Glenohumeral Joint Injection

The procedure for a glenohumeral (shoulder) joint injection involves several steps, including:

• Patient preparation, which may include preprocedural medication such as diazepam and Hydrocodone-Acetaminophen 2
• Injection of a solution, such as lidocaine mixed with triamcinolone acetonide, through an anterior approach at the level of the rotator interval for pain control 2
• Fenestration of the superior glenohumeral ligament (SGHL) 2
• Hydrodilatation of the glenohumeral joint (GHJ) through a posterior approach with approximately 50 mL of 0.9% normal saline, or until an expansion and release of the GH joint is visualized under ultrasound visualization 2

Types of Injections

Different types of injections can be used for glenohumeral joint injections, including:

• Corticosteroid injections, which have been shown to have a rapid decrease in efficacy at follow-up 3
• Hyaluronic acid (HA) injections, which have been shown to have a good efficacy at follow-up compared to baseline 3, 4
• Viscosupplementation agents, which can be used as an alternative to corticosteroid injections 5

Guidance and Evidence

There is limited guidance and evidence for injectable treatments to the glenohumeral joint, and more research is needed to compare the efficacies of different injection options 3, 6