Procedure

Acromioclavicular Joint Injection

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Acromioclavicular Joint Injection, AC Joint Injection

  • See also
  1. Shoulder Injection
  2. Glenohumeral Joint Injection
  3. Subacromial Space Injection
  4. Long Head of Biceps Injection
  5. Scapulothoracic Injection
  6. Joint Injection
  7. Injectable Corticosteroid
  • Indications
  1. Osteolysis of distal clavicle
  2. Osteoarthritis
  3. Acromioclavicular Separation (Refractory Pain)
  • Preparation
  1. Needle: 25-27 gauge, 1 to 1.5 inch
  2. Intraarticular Corticosteroid
    1. Methylprednisolone: 0.25 - 0.50 ml of 40 mg/ml or
    2. Betamethasone (Celestone Soluspan): 0.25 to 0.50 ml
  3. Lidocaine 1% or Bupivicaine 0.5%: 0.5 ml
    1. Use additional 1-2 ml of Anesthetic first to raise a skin wheal over injection site
  • Approach
  1. Images
    1. OrthoShoulderInjectAC.jpg
  2. Patient positioning
    1. Patient sits with arm resting at side
    2. Shoulder externally rotated
  3. Landmarks: Identify AC joint
    1. Palpate clavicle to distal aspect
    2. Slight depression where clavicle meets acromion
    3. Ultrasound guided injection improves success from 40% to >90%
      1. Mikell (2020) Am J Emerg Med 38(1): 162.e3-162 +PMID: 31427163 [PubMed]
  4. Injected with sterile technique
    1. Insert needle from anterior and superior approach
    2. Direct needle inferiorly
  • References
  1. Pfenninger (1994) Procedures, p. 1036-54
  2. Larson (1996) Am Fam Physician 53(5):1637-43 [PubMed]
  3. Tallia (2003) Am Fam Physician 67(6):1271-8 [PubMed]