Procedure Name: Shoulder Joint Injection
Indication: Pain
Location: *******
Pre-Procedure Diagnosis: ****
Post-Procedure Diagnosis: Same
Informed Consent and Counseling: The procedure, alternative treatment options, risks, and benefits were thoroughly explained to the patient and informed consent was obtained.
Appropriate equipment and medications were set up.
PROCEDURE:
The appropriate timeout was taken. We identified and marked the appropriate anatomic landmarks to guide needle placement.
The area was prepped in the usual sterile fashion and the overlying skin cleaned using isopropyl alcohol (**povidone iodine [Betadine] was an available alternative).
Local anesthesia achieved using Ethyl Chloride spray (Cooling spray). 5 ml of Lidocaine 1% without epinephrine and 1ml of Kenalog 40 mg/1mL in a needle of appropriate length and gauge was injected into the joint using *** posterior/anterior approach. Gentle aspiration before injection didn’t show any blood.
Estimated blood loss was less than 0.5 cc.
A dressing was applied to the area. Anticipatory guidance, as well as standard post-procedure care, was explained. Return precautions were given. The patient tolerated the procedure well without complications. Follow-up visit scheduled.
—-END OF PROCEDURE NOTE—-
As you inject, the medication should move freely into the intended space. If resistance is met, try rotating or repositioning syringe to ensure that the needle is still in the correct space.
** Dr. Stabile, an orthopedic doc I worked with in the past injects 1:9 ratio of Kenalog to steroids to get 10 ml!!!
Great Resources on Shoulder Injections
This article from AAFP is excellent. Start here: Diagnostic and Therapeutic Injection of the Shoulder Region
Subacromial Injections
Glenohumeral Injections
Video #1: https://www.youtube.com/watch?v=OAeOEc-X0kU
Video #2: