steroid injection/ aspiration

1. INTRA-ARTICULAR
INJECTION / ASPIRATION
DR SHARAN

2. NECESSARY MATERIALS
• Sterile gloves
• Syringes
• Needle
• Povidone-iodine solution
• Ethyl cloride spray
• Alcohol swabs
• Gauze pads
• Band aid

3. SHOULDER
• Posterior approach
Glenohumeral
subacromial
• Anterior
Glenohumeral

4. POSTERIOR
• Patient in seated position ith affected arm at
resting on arm side with shoulder internally
rotated
• Examine posterior aspect for any cellulitis
(potential infection)
• Palpate posterior and lateral aspect of acromion
process, and corocoid process anteriorly
• Localize the postero-lateral aspect soft spot
between head and glenoid cavity approx 2
fingerbreadth distal and 1 fingerbreadth medial

6. • Prepare skin using alchol and povidine
• Put on sterile gloves
• Spray ethyl chloride
• Inject in the direction of coracoid process and
medially slightly superiorly
• For subacromial space needle aimed
superiorly at a 10 to 15 degree angle to end
up just distal to undersurface of acrmion
process

8. • Aspirate first and then inject the steroid
• Clean the site
• Apply band aid

9. ANTERIOR
• Patient in seated position ith affected arm at
resting on arm side with shoulder in neutral or
slightly externally rotated
• Examine anterior aspect for any cellulitis
(potential infection)
• Palpate coracoid process and humeral head
• Make starting point just medial to humeral
head and 5 to 10 mm lateral to tip of coracoid
process

10. • Prepare skin using alcohol and povidine
• Put on sterile gloves
• Spray ethyl chloride
• Direct needle slightly lateral and slightly
superior
• Aspirate first and then inject the steroid
• Clean the site
• Apply band aid

12. KNEE
• Supero- lateral
• Supero- medial
• Infero- lateral
• Infero- medial
Superio lateral has shown most accurate and
reproducible

13. SUPERO - LATERAL
• Patient in supine position with knee fully
extended
• Examine for overlying cellulitis
• Palpate superio – lateral aspect of patella and
mark 1 fingerbreadth superior and 1
fingerbreadth lateral

15. • Prepare skin using alchol and povidine
• Put on sterile gloves
• Spray ethyl chloride
• Direct needle 45 degree distally and 45 degree
posteriorly
• Aspirate first and then inject the steroid
• Clean the site
• Apply band aid

17. INFERO - LATERAL
• Patient in seated position with knee flexed
over end of examination table to 90 degree
• Examine for overlying cellulitis
• Palpable soft spot present one fingerbreadth
to lateral tibial plateau just lateral to the
lateral aspect of patellar tendon

19. • Prepare skin using alchol and povidine
• Put on sterile gloves
• Spray ethyl chloride
• Direct needle 30 degree medially toward the
intercondylar notch
• Aspirate first and then inject the steroid
• Clean the site
• Apply band aid

21. THANK YOU