Intraarticular injection of the acromioclavicular joint is used to treat an inflamed or painful joint, as well as pain secondary to acromioclavicular joint separation.
After informed consent is obtained, the patient is placed in the sitting position. The acromioclavicular joint is palpated by placing the fingers at the tip of the distal clavicle and medial to the tip of the acromion. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 1-in. (2-cm), 25-gauge needle is inserted at the joint and advanced to the proximal margin of the joint surface. After negative aspiration, the periarticular area is injected with 2 mL of 1% lidocaine for diagnostic purposes. If the local anesthetic provides significant pain relief, the periarticular area should be injected with a 2-mL mixture of 10 mg of triamcinolone acetonide (or equivalent) and local anesthetic (Fig. 67-37A).
FIGURE 67-37. Shoulder joint injections. A: Approach for shoulder joint aspiration and injection. Acromioclavicular joint injection. B: Approach for shoulder joint aspiration and injection. Rotator cuff tendon/subacromial bursa injection.
Comments It is not necessary to advance the needle into the acromioclavicular joint. Infiltration of the superficial tissue over the interosseous groove of the joint at the point of maximal tenderness is usually adequate.
Serious complications are uncommon with injection of the acromioclavicular joint.