The Shoulder

Technique:

• The therapist takes hold of the scapula: index (and middle finger) on the coracoid process and thumb on the posterior angle of the acromion.
• The hypothetical line between these two landmarks crosses the upper-posterior articular surface of the humeral head and the joint capsule.
• The needle is inserted about 1 cm below the palpating thumb and aimed at the coracoid process.
• After 2 to 4cm it is stopped by the articular surface of the head of the humerus (tough resistence is felt on passing through the capsule).
• With the needle in cartilaginous contact, the 2 ml of triamcinolone are injected here. Not too much resistance is encountered.
• Should this be the case, the point of the needle is fully within the cartilage and should be turned over 180° while pressure is maintained.
• Once the bevel turns away from the cartilage, the steroid floats in.