This document provides guidance on shoulder injection techniques for various shoulder conditions. It discusses indications, anatomy, imaging and injection sites for the glenohumeral joint, acromioclavicular joint, supraspinatus tendon, infraspinatus tendon, subscapularis tendon, bicipital tendinitis, subacromial impingement syndrome, rotator cuff tears, and frozen shoulder. Ultrasound guidance is recommended for many of the injections to ensure accurate needle placement. The goal of the injections is to reduce pain and inflammation in the shoulder to improve range of motion and function.

1. Shoulder Injection
Ade Wijaya, MD – September 2018
Reference: 2017 Atlas of Pain Management Injection Techniques

2. Outline
 Glenohumeral joint
 Acromioclavicular joint
 Supraspinatus tendon
 Infraspinatus tendon
 Subscapularis tendon
 Bicipital tendinitis
 Subacromial impingement syndrome
 Rotator cuff tear
 Frozen shoulder

3. Intra-Articular Injection of
the Glenohumeral Joint

4. INDICATIONS AND CLINICAL CONSIDERATIONS
 The shoulder joint is susceptible to the development of arthritis
 Pain worse with activity, interfere sleep, crepitus might be found
 Limited ROM to do daily activities

5. Anatomy

6. Injection Site

7. USG-Guided Injection

8. Acromioclavicular Joint Injection

9. INDICATIONS AND CLINICAL CONSIDERATIONS
 The acromioclavicular joint is vulnerable to injury
from both acute trauma and repetitive microtrauma
 Increased pain when reaching across the chest. Often
the patient is unable to sleep on the affected
shoulder

10. IMAGING

11. Injection Site

12. USG-Guided Injection

13. Supraspinatus Tendon Injection

14. INDICATIONS AND CLINICAL CONSIDERATIONS
 Shoulder prone to tendinitis due to:
1. Wide range of motion
2. Restricted by coracoacromial arch
3. Poor blood supply
 Supraspinatus tendinitis usually acute, occurring after overuse or misuse of
the shoulder joint
 Carrying heavy objects
 Vigorous use of exercise equipments
 Positive Dawbarn sign
 Often with bursitis

15. Dawbarn’s Test / Dawbarn Sign
 Pain on palpation over the greater tuberosity of the humerus when the arm is
hanging down that disappears when the arm is fully abducted

16. Ultrasound

17. Ultrasound

18. Injection Site

19. Infraspinatus Tendon Injection

21. Ultrasound
Normal Tendinopathy

22. Subscapularis Tendon
Injection

23. Imaging

24. Injection Site

25. Long Head of the Biceps Injection
for Bicipital Tendinitis

27. Anatomy

28. Physical Examination
 Yergason test, which is production
of pain on active supination of the
forearm against resistance with the
elbow flexed at a right angle
 Popeye deformity

29. Ultrasound

30. Injection Site

31. Injection Technique for
Subacromial Impingement Syndrome

32. INDICATIONS AND CLINICAL CONSIDERATIONS
 Diffuse shoulder pain with an associated feeling of weakness combined with
loss of range of motion.
 Worsened at night and impair sleep
 Increasing shoulder pain with any activities that abduct and/or forward flex
the shoulder
 Positive neer’s test

34. Anatomy

35. Etiology

36. MRI

37. Injection Site

38. USG-Guided Injection

39. Injection Technique for
Rotator Cuff Tear

40. MR arthrogram

42. Injection Site

43. USG-Guided Injection

44. Injection Technique for
Frozen Shoulder Syndrome

45. INDICATIONS AND CLINICAL CONSIDERATIONS
 The term frozen shoulder describes a constellation of clinical symptoms,
including the unilateral progressive limitation of passive and active range of
motion of the shoulder and pain on range of motion.
 Frozen shoulder is distinguishable from other painful conditions of the
shoulder, such as tendinitis and bursitis, in that the limitation of range of
motion associated with frozen shoulder affects both passive and active range
of motion, whereas tendinitis and bursitis affect only active range of motion.

46. Injection Site

47. Treatment

48. USG-Guided
Injection