Ultrasound Guided Injection for Shoulder Impingement

If you have pain in your shoulder caused by a shoulder impingement, your consultant may recommend having an ultrasound guided injection to reduce inflammation and relieve pain. Here we explore what an ultrasound guided injection is, what conditions it’s used for and what to expect when you go for your appointment.

---

What is shoulder impingement?

Shoulder impingement is a common cause of shoulder pain. It occurs when the rotator cuff, which is the group of muscles and tendons that attach your shoulder to your upper arm bone, rubs against the acromion, which is the top of the shoulder. This can cause irritation and inflammation.

If you lift your arm, the space between the rotator cuff and the acromion narrows which increases pressure and can lead to impingement. The symptoms of shoulder impingement include pain in your shoulder when you lift your arm overhead or backwards. The pain may be worse at night and your shoulder may be weakened.

Shoulder impingement can occur in active adults, particularly as they age.

---

What is an ultrasound guided injection?

Injecting a mix of steroid and local anaesthetic into an inflamed shoulder joint can help to reduce inflammation and relieve pain. The accuracy of injections without ultrasound guidance is around 63-79%. However, with ultrasound guidance, accuracy of 90-100% is possible.

This means that more of the medication is reaching the affected parts of your joint, resulting in safer, more effective treatment and greater relief from symptoms. Ultrasound is quick, non-invasive and does not expose your body to radiation like X-rays do.

---

What is it used for?

There are different types of ultrasound guided injections used to treat a range of conditions, including:

• Subacromial bursal injection for impingement.
• Acromio-clavicular joint injection for arthritis and/or inflammation.
• Shoulder joint injection for arthritis or frozen shoulder.
• Long head of biceps tendon injection for inflammation.
• Suprascapular nerve block injection for rotator cuff arthropathy

---

What to expect

You will be seen by a consultant radiologist, radiographer and healthcare assistant. Your appointment will normally last around 25 minutes. Here is our step-by-step guide to your ultrasound guided injection:

1. You will be asked to sign a consent form detailing the treatment you are about to have and stating that you understand any risks. These are minimal and will be discussed with you by the consultant performing the injection prior to the procedure.
2. You will sit on a chair next to the ultrasound machine throughout your treatment.
3. The team will prepare an injection of cortisone, to reduce inflammation around the shoulder, and anaesthetic to block the pain.
4. The skin of your shoulder will be cleaned with a sterile solution to reduce the risk of infection.
5. The ultrasound probe is placed against your shoulder so the consultant can see the location of the bursa on the computer screen. This helps to ensure absolute accuracy and precision of the injection.
6. First an injection of anaesthetic is given to numb the skin.
7. Once the skin is numb, an injection of steroid and anaesthetic is administered into the affected area.

---

Aftercare

The injection site may feel a little sore and you may experience an increase in pain in the joint temporarily until the treatment starts to take effect.

You should avoid doing anything too strenuous for 48 hours after the procedure and, if you have been doing physiotherapy exercises you should continue to regain the maximum movement in your shoulder.

Ultrasound guided injections generally produce good results and you should experience a reduction in pain and greater mobility in your shoulder.

---