The arm of the seated patient may rest on the patient's knee.
Alternatively the patient may be placed in a semi-prone position with the affected shoulder uppermost.
The needle is most frequently introduced lateral to the ultrasound transducer
and directed obliquely towards the posterior labrum.
a medial puncture can be used but generally there is less room to manoeuvre
Care should be taken not to aim for the glenoid margin itself as a large labrum may displace the needle posteriorly and prevent accurate placement into the joint.
The intra-articular position of the needle can be confirmed by injecting a small amount of local anaesthetic.
If the needle is correctly positioned, the injected local anaesthetic will disappear into the joint and no resistance will be felt.
SHOULDER DISTENSION FOR FROZEN SHOULDER
Prepare the following syringes
• 20mls of a mixture of local anaesthetic, normal saline
• 20mls normal saline
• 2mls 80mg methylprednisolone
The joint can be targeted either via a posterior approach or through the anterior interval
Once the joint is cannulated, a short flexible tube and a three-way connector tap is attached
Attach the 2ml and the first 20ml syringe with local and saline to the tap
Confirm intraarticular positioning has been maintained and then inject the 2ml methylprednisolone
Begin injecting the first the 20ml and continue until the patient reports symptoms
Close the tap, then continue with small aliquots closing the tap between each and assessing patient tolerance
Warn the patient that the joint may decompress with a slight popping sensation
If the patient tolerates the injection of the first 20mls, the three-way tap is closed and the second 20ml syringe is attached.
The use of the three way tap prevents decompression of the joint as the syringes are being exchanged.
The aim is to inject a volume beyond joint capacity in an effort to stretch the capsule and improve the patients range of motion.
Stop at 40ml. or when the patients reaches tolerance or if the joint decompresses.
