The subacromial bursa and subacromial space may be injected in cases of subacromial impingement with symptoms of rotator cuff tendonitis or a painful arc syndrome. It may also be appropriate in some cases of calcific tendonitis. When used as a diagnostic procedure, for instance differentiating subacromial impingement from glenohumeral joint disease, it should be remembered that in the presence of a full thickness degenerative rotator cuff tear that the subacromial space will communicate with the glenohumeral joint.
The subacromial bursa may be injected via a lateral/posterolateral or anterior approach.
The dose of steroid used varies between different preparations and guidance is often available on package inserts. The mixing of the injection with local anaesthetic varies between operators though some operators feel that its inclusion helps determine if the injection has been placed correctly.
Appropriate informed consent, aseptic technique and aftercare instructions with rest of the shoulder for 24-48 hours should be applied in all cases.
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