The Shoulder

Technique:

• The patient sits in the same position as described for palpation.
• Identification of the joint line.
• The needle is inserted from above, in the middle of the joint line and pushed further in a slightly oblique direction - from cranio-lateral tot caudo-medial.
• A small distal traction on the arm eases the penetration.
• First the superficial ligament is encounterd then the meniscus and finally, at about 1.5 to 2 cm from the surface, the deep ligament.
• The needle must therefore be slid in almost to its full length until the deep ligament is reached.
• The structure is then infiltrated fanwise.
• The droplets are deposed when the typical ligamentous resistance is encounterd.