What are the recommendations for administering steroid injections in the left acromioclavicular (AC) joint and the right shoulder of a 64-year-old male patient?

Steroid Injections for Acromioclavicular and Shoulder Joints

Intra-articular corticosteroid injections are strongly recommended for the left acromioclavicular joint and right shoulder in this 64-year-old male patient to reduce pain and improve function. 1, 2

Injection Guidelines and Technique

Acromioclavicular Joint Injection

• Dosage: 2.5-5 mg triamcinolone acetonide 3
• Technique: Consider image guidance (ultrasound or fluoroscopy) for accurate placement
  • Studies show only 24% of clinically-guided AC joint injections are accurately placed 4
  • Accurate placement significantly improves outcomes and prevents misdiagnosis
• Local anesthetic: Mix with 1-2 cc lidocaine for immediate pain relief 2

Shoulder (Glenohumeral/Subacromial) Injection

• Dosage: 5-15 mg triamcinolone acetonide for larger joints 3
• Technique: Strict aseptic technique is mandatory
• Ultrasound guidance: Strongly recommended for hip joints; optional but beneficial for shoulder injections 1, 2

Expected Benefits and Outcomes

• Pain reduction: Significant short-term pain relief allowing better participation in rehabilitation 2
• Duration of benefit:
  • AC joint: Studies show improvement lasting from 20 days 5 up to 5 years 6 with most significant benefit in the first 12 months
  • Shoulder: Effects typically last 4-8 weeks 2
• Functional improvement: Improved range of motion, particularly extension and horizontal flexion in AC joint arthropathy 7

Important Limitations and Precautions

• Frequency limitations: No more than 3-4 injections per year with minimum 6-8 weeks between injections 2
• Post-injection care:
  • Avoid overuse of the injected joint for 24 hours, though complete immobilization is not recommended 2
  • Monitor for transient increased blood glucose levels, particularly important in diabetic patients 2
• Potential complications:
  • Transient post-injection pain flare may occur
  • Multiple repeated injections may potentially contribute to cartilage loss, though clinical significance remains uncertain 2
  • Infection risk is very low but should be discussed with the patient

Complementary Management

• Physical therapy: Should be continued during and after injection therapy to maximize benefits 2
• NSAIDs: May be used concurrently for additional pain management 2
• Follow-up: Evaluate response to determine if additional injections are warranted based on meaningful relief from previous injection

By following these evidence-based guidelines for corticosteroid injections in both the acromioclavicular joint and shoulder, you can provide effective pain relief and improved function for this 64-year-old male patient.