MSK Ultrasound Procedures


Acromioclavicular Joint Injection


Equipment and Medications

  • probe: 14Mhz hockey stick probe
  • 25g 1.5” needle
  • 3cc syringe with 1cc 0.5% ropivacaine and 1cc injectable steroid (kenalog 40mg/cc)
  • 5cc syringe with 5cc of 1% Lidocaine
  • Procedure tray

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    Equipment

    Medications

    Procedure Instructions:


    Instructions
    1. Standard pre procedure workup (consent, indications, contraindications, allergies). Assess pain level.
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      • MRI correlation
    2. Position patient laying flat supine, considering turning patient head away from probe. Picture of probe on anterior aspect of AC joint
    3. Place probe parallel to the joint and mark probe location and probable injection site
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    4. Clean x 3 with betadine or chlorhexidine.  
    5. Sterile drape and sterile probe cover.  
    6. Inject 1% lidocaine superficially with 25g 1.5” needle. Advance needle until you have purchase. Then, unscrew syringe from needle for greater needle control.  
    7. Under ultrasound guidance, advance needle into the AC joint. Test inject with 1% lidocaine. If no resistance, switch 1% lidocaine for injectable steroid mixture. If there is resistance, reposition needle and test inject again. Inject 0.5 -1 cc of injectable steroid/anesthetic mixture.
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    8. Pull needle out and follow standard post-procedure protocol with cleaning off the skin and placing a bandage. Post procedure transverse images demonstrating distention of the joint with steroid and anesthetic.
    9. Assess pain level.

     

    References

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