Bicep's Tendon Sheath Injection
Equipment and Medications
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Equipment 
Medications |
Procedure Instructions:
| Instructions | |
| 1. Standard pre procedure workup (consent, indications, contraindications, allergies, document pain level if any) | |
| 2.Position patient recumbent with forearm supinated (palm up) with biceps tendon you are working on far side from ultrasound machine. |  |
| 3. Scan patient looking at the biceps tendon (short axis/transverse) extra-articular and at the rotator interval. If there is fluid in the biceps tendon sheath when extra-articular, you can inject at that site. Otherwise, will need to inject at the rotator interval. |
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| 4. Mark needle site and ideal probe location. | |
| 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 a wheal underneath the skin using a 25g needle with the 1% lidocaine at the site marked for the needle. With ultrasound guidance place the 1% lidocaine deeper within the subcutaneous tissues. |  |
| 9. Once numb, leave 25 gauge needle in soft tissues, disconnect syringe for greater control. | |
| 10. With ultrasound guidance, advance the 25g needle into the sheath surrounding the tendon. |
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| 11. Test inject to see if easy flow with 1% lidocaine. If no resistance and see distention of the tendon sheath, exchange for 3cc syringe with injectable steroid and ropivacaine. | |
| 12. Scan sheath to demonstrate distention. |
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| 13.Pull needle out, wash skin with alcohol and place bandage on skin. |
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| 14.Document pain level and give patient pain log. |
References
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