Cause and findings:
• Overuse
• Pain in deltoid area
• Painful: resisted abduction arc on active abduction
Equipment:
Syringe - 5ml
Needle - 25G 0.5 inches (16mm) orange
Kenalog 40 - 10 mg
Lidocaine - 0.75 ml 2%
Total volume - 1 ml
Anatomy:
The supraspinatus tendon inserts into the superior facet on the greater tuberosity of the humerus, which lies in a direct line with the lateral epicondyle of the elbow. A line joining the two points passes through the tendon, which is approximately the size of the middle finger at insertion.
Technique:
• Patient sits supported at about 45° with forearm medially rotated behind back, bringing the tendon forward so it lies just anterior to the edge of the acromion
• Identify rounded tendon in the hollow between acromion and tuberosity, in direct line with the lateral epicondyle
• Insert needle perpendicularly through tendon to touch bone
• Pepper solution perpendicularly into tendon
Aftercare:
Relative rest is advised for up to 2 weeks. A progressive exercise and postural control regime is begun when symptom-free.
Comments:
There is much controversy about injecting tendons because of the possibility of rupture. If the patient is elderly and the cause is traumatic, an ultrasound scan should be performed to determine if there is a tear in the tendon. Deep friction and a muscle balancing regime may then be the better treatment but surgery may be advised in some cases.
Alternative approaches:
Supraspinatus tendinopathy can occur on its own but is often associated with subacromial bursitis. If there is doubt about the existence of a double lesion,
the bursa should be injected first. If some pain remains on resisted abduction, then the tendon can be infiltrated a week or so later. Calcification can arise within the tendon and a hard resistance would then be felt with the needle. It is worth attempting to break up the calcification with a large-bore needle and local anaesthetic. The results are variable. If symptoms persist a surgical opinion should be sought.
0 comments:
Post a Comment