Shoulder Ultrasound Guided Injections
Due to modern technology, diagnostic shoulder ultrasound has overtaken MRI imaging as the premium imaging modality to assess the majority of shoulder pain conditions...
Shoulder Diagnostic Ultrasound Scan
The Anatomy of a Shoulder Ultrasound Scan
Diagnostic ultrasound has become the gold standard for many common musculoskeletal shoulder pain conditions. Due to the ability to visualize small defects in tendons, underlying bony attachment of tendons and the ability to stretch and load specific structures of the shoulder due to the range of motion available, A shoulder ultrasound scan is able to define small changes including:
Areas of rotator cuff tendinopathy
rotator cuff tears, location and precise measurements
distention and thickening to this subacromial bursa
Thickening to the ligaments of the rotator interval, common in frozen shoulder
long head of biceps tenosynovitis and tears
AC joint arthritic changes
Shoulder (glenohumeral) joint arthritic changes and joint effusion
Irrespective of the probable diagnosis a shoulder ultrasound scan normally follows a relatively defined protocol...
Initially, the long head of the biceps tendon is visualized in a transverse view and a longitudinal axis view with any areas of tendon sheath effusion, tendon thinning or tearing noted.
The pectoralis major tendon can be well visualized attaching to the humerus towards the lower end of the long head of the biceps tendon.
The next step is a detailed examination of one of the rotator cuff tendons, the subscapularis. The subscapularis is scanned in a longitudinal and a transverse orientation and Is checked for its characteristic striped fiber pattern as well as any tendon tears.
The supraspinatus tendon is next examined and checked for its normal characteristic bony attachments known as the greatest tuberosity as well as for any areas of tendon thickening or tears within the body of the supraspinatus tendon.
While imaging the supraspinatus tendon in a transverse orientation the clinician will often take measurements of the subacromial subdeltoid bursa.
The acromioclavicular (AC) joint will be checked for any capsular thickening or significant bony regularity and keeping with an injury or arthritis at this joint.
Finally towards the back of the shoulder, the infraspinatus tendon of the rotator cuff will be imaged as well as the shoulder (glenohumeral) joint recess being checked for any joint fluid or areas of bony irregularity which may indicate previous injury or arthritis.
Types of Shoulder Ultrasound Guided Injections
Frozen Shoulder Ultrasound Guided Injections
Shoulder injections can be broadly defined as three types of injections. Firstly, a shoulder intra-articular injection alternatively known as a glenohumeral intra-articular injection which is performed under ultrasound guidance to ensure the needle is placed within the shoulder joint capsule. A shoulder ultrasound guided injection is normally performed from the back of the shoulder (known as the posterior aspect of the shoulder) which means it is a very safe and relatively pain-free way of delivering high volumes of steroid within the the shoulder joint cavity. Conditions which benefit from an intra-articular shoulder joint injection include a frozen shoulder but also stiff and painful shoulders due to shoulder joint (glenohumeral joint) osteoarthritis. If you would like further detailed information regarding evidence-based treatments for a frozen shoulder please visit frozenshoulderexpert.co.uk before considering your options.
Patient's that have read up on a shoulder injection procedure known as a shoulder hydrodilatation injection should be aware that this type of injection is very similar to a standard shoulder joint intra-articular injection and again should visit the dedicated page at frozen shoulder expert which discusses this is in detail... https://www.frozenshoulderexpert.co.uk/treatment
Sub-Acromial Ultrasound Guided Injections
The second type of shoulder injection performed is known as a sub-acromial shoulder injection which essentially means an injection to the tissues at the top of the shoulder joint (the sub-acromial region of the shoulder). The needle is guided either within the sub-acromial bursa or into an area of rotator cuff tendon defect. The exact location of the injection will depend on a patient's symptoms as well as ultrasound imaging findings. Again these injections should always be conducted under ultrasound guidance as there is very little chance of hitting the target accurately without image guidance.
AC Joint Ultrasound Guided Injections
Lastly, patients with shoulder pain focally on top of the bony part of the shoulder known as the acromioclavicular joint (AC joint) should be considered for a shoulder acromioclavicular joint injection delivered by ultrasound guidance. When patients have an accurate diagnosis of acromioclavicular joint pain whether it is osteoarthritis of the AC joint or other causes an acromioclavicular joint injection is normally extremely helpful at alleviating pain.