Injection of the subacromial subdeltoid bursa is a commonly performed procedure.
It is a large bursa and can be accessed by a variety of routes.
The commonest approach for a blind injection is via a posterior approach.
Ultrasound guided injections are generally from a superolateral or anterior approach.
Keeping the tip of the bevel downwards allows easy passage of the needle into the bursa.
Once transgressed, rotating the needle through 180 places the needle fully within the space.
A preliminary injection should demonstrate rapid flow of injected material away from the needle tip.
Focal accumulation of injected fluid indicates incorrect positioning with the needle tip most commonly still lying on the deltoid side of the bursa.
Gentle advancement of the needle with a slight hooking action to direct the needle under the reflective bursal surface is usually adequate to ensure placement within the bursa and the injection can be completed.
