|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.|