|
Equipment Medications |
Instructions | |
1. Standard pre procedure workup (consent, indications, contraindications, allergies) | |
2. Position patient with lateral decubitus with contralateral shoulder down with arm in cross adduction. | |
3. Scan patient looking for the posterior glenohumeral joint space. Image at the level of the infraspinatus tendon insertion in longitudinal orientation. Position probe so you can inject from anterior. | |
4. Mark needle site and probable injection site. | |
5. Prep patient; betadine or chlorhexidine x 3. Clear wide area. | |
6. Place sterile drape and probe cover. | |
7. Draw up medications as listed in equipment list. | |
8. Place sterile ultrasound probe on skin and find site of injection again and inject 1% lidocaine superficially via the 25g 1.5” needle. | |
9. Exchange 25g 1.5" needle for the 22g 3.5” needle | |
10. Advance needle under ultrasound guidance to the level of the articular cartilage (hypoechoic line). | |
11. Test inject to see if easy flow with 1% lidocaine. Look for accumulation of fluid or microbubbles in overlying soft tissue. If no resistance and see distention of the joint space inject 3-5cc of Lidocaine 1%. If there is resistance, step off articular cartilage slightly and try again. |
|
12. Exchange Lidocaine 1% for Normal Saline and Gadolinium mixture. Inject full 10cc of mixture. | |
13. Document distention of the posterior joint recess with ultrasound. |
|
14. Clean off area and place bandage over skin | |
15. Send patient for MRI. |