Subacromial Injection
Subacromial injections are a targeted approach for alleviating shoulder pain; they are especially beneficial for those struggling with repetitive use injuries. These injections, which are part of a comprehensive pain management plan, offer a minimally invasive alternative to more extensive surgical procedures. They are frequently recommended for both acute and chronic shoulder conditions, providing patients with a non-surgical option for pain relief.
What You Need To Know About a Subacromial Injection
Subacromial Injections Explained
A subacromial injection, sometimes called a subacromial bursa injection or a bursal injection, involves the administration of corticosteroids (like triamcinolone) and an anesthetic (like lidocaine) into the subacromial space, a specific area between the acromion (part of the shoulder blade) and the humerus (upper arm bone). It's an effective intervention for conditions such as adhesive capsulitis (frozen shoulder), rotator cuff tendinosis, and impingement syndrome, where painful inflammation restricts movement and function. The anesthetic provides immediate but temporary relief, while the long-term benefits are attributed to the anti-inflammatory effects of the corticosteroid.
This procedure is particularly beneficial for inflammatory conditions in the shoulder that have not responded to first aid measures like rest, ice, compression, elevation, and NSAID (non-steroidal anti-inflammatory drug) use. By targeting the inflamed or irritated rotator cuff tendon or subacromial bursa, these injections can significantly reduce pain and restore mobility.
When a Subacromial Injection Becomes a Necessity
If the first aid measures mentioned above prove to not be effective at relieving shoulder pain and restoring mobility, a potential solution, before resorting to surgical intervention, would be a subacromial injection.
The subacromial space within the shoulder joint is a critical area where inflammation can severely impede arm movement. By directly administering medication to the source of the pain and inflammation, physicians can often effectively provide patients with fast and lasting relief. The injection can also provide relief to conditions other than those that affect the shoulder; conditions like osteoarthritis, rheumatoid arthritis, and cartilage or labral tears can also benefit from this targeted approach, making it a versatile treatment option for various ailments that restrict joint movement.
Preparing for a Subacromial Injection Procedure
Prior to a subacromial injection, no extensive preparation is necessary. However, it's important to bring any previous imaging studies like X-rays, ultrasounds, CT, or MRI scans to your appointment. If you haven't had imaging done elsewhere, the expert physicians at Resurgens will be able to provide you with the proper imaging services. These images will provide valuable information about your shoulder's condition.
If you are on blood-thinning medications, particularly warfarin, it's crucial to inform the radiology facility ahead of time. Adjustments to these medications might be necessary to reduce the risk of bleeding during the procedure. Your physician will give specific instructions about modifying or temporarily stopping these medications. On the day of the procedure, a blood test may be required to check your blood's clotting ability. Continue taking your regular pain medication and other prescribed treatments unless advised otherwise.
What Happens During a Subacromial Injection?
The subacromial injection process begins with you sitting comfortably with your shoulder exposed. First, the injection site is cleaned and then numbed to minimize discomfort. The physician then carefully guides a needle between the acromion and the humerus to administer the medication. The approach for the injection can vary (front, side, or back of the shoulder) based on the physician's training and preference.
The procedure itself is quick, typically not exceeding 5 minutes, but with preparation, such as scanning, marking, and explaining, the total duration could be around 15 minutes. If an ultrasound is also requested to assess the area, the entire process might extend to 30 minutes.
Are There Risks Associated With a Subacromial Injection?
While a bursal injection is generally safe, it is not without some potential risks and side effects. Complications, though rare, include:
Subcutaneous fat atrophy
Skin atrophy
Temporary skin depigmentation
Postinjection flare, a painful reaction that typically lasts less than 48 hours
Infection
Damage to tendons, nerves, or blood vessels from incorrect needle placement
Temporary spike in blood sugar levels for diabetic patients
Allergic reactions
It's important to note that the risk of tissue atrophy increases with repeated injections, particularly in areas with significant wear or tear. It's generally advised not to exceed three to four injections per year in the same area to avoid this complication. It's crucial to monitor for signs of infection post-procedure, such as worsening symptoms, fever, or feeling unwell.
Post Subacromial Injection & Recovery
Post-procedure, the injected area is bandaged. We recommend rest for a few days to allow healing; however, complete immobilization of the shoulder is not advised to avoid the development of a frozen shoulder. Application of ice and the use of NSAIDs, unless advised otherwise, can help manage pain. If pain increases progressively after several hours or persists beyond 48 hours, a reassessment is necessary to exclude infection.
You can expect to start gentle range-of-motion exercises after 24 hours, gradually increasing intensity over two weeks. Immediate relief may be felt due to the anesthetic in the injection, but this is temporary. A steroid flare, characterized by increased pain for 24-48 hours post-injection, can be treated with ice, NSAIDs, or acetaminophen. The full pain-relieving effect of the steroid medication typically takes 2 to 7 days.
If you're experiencing shoulder pain and restricted mobility, you could be a good candidate to find relief through a subacromial injection. Schedule an appointment with a Resurgens physician who will provide a comprehensive assessment and discuss whether this treatment is suitable for you. Trust Resurgens Orthopaedics for expert care and a path to improved shoulder function and pain relief.