Acromioclavicular Joint Injection

Shoulder
Equipment & Medications

Equipment

14 MHz Hockey Stick Probe 25g 1.5″ Needle 5 cc Syringe (lidocaine) 3 cc Syringe (steroid mix) Procedure Tray

Medications

Lidocaine 1% — 5 cc Kenalog 40 mg/cc — 1 cc Ropivacaine 0.5% — 1 cc
Procedure Steps
1

Standard pre-procedure workup: consent, indications, contraindications, allergies. Assess baseline pain level.

2

Position patient supine. Consider turning the patient's head away from the side being injected.

AC joint MRI correlation
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3

Place the hockey-stick probe parallel to the AC joint and mark probe location and needle entry site.

AC joint ultrasound long axis
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AC joint ultrasound alternate
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4

Prep with betadine or chlorhexidine × 3.

5

Place sterile drape and sterile probe cover.

6

Inject 1% lidocaine superficially with the 25g needle. Advance until you have bony purchase. Disconnect 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, exchange for the steroid/anesthetic mixture. Inject 0.5–1 cc.

Needle in AC joint
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8

Remove needle and follow standard post-procedure protocol. Scan post-injection to confirm joint distension.

9

Reassess pain level.

References

  1. Edelson G, Saffuri H, Obid E, et al. Successful injection of the acromioclavicular joint with use of ultrasound: anatomy, technique, and follow-up. J Shoulder Elbow Surg. 2014;23(10):e243–e250.
  2. Park KD, Kim TK, Lee J, et al. Palpation versus ultrasound-guided acromioclavicular joint intra-articular corticosteroid injections: a retrospective comparative clinical study. Pain Physician. 2015;18(4):333–341.