What is a subacromial space?
A subacromial space is the area below the top of the shoulder blade (acromion) and above the rotator cuff tendons present on the top of the bone of the upper arm (humerus). Inflammation of the rotator cuff tendon or subacromial bursa present in the subacromial space can lead to painful symptoms.
What is a shoulder subacromial injection?
Injecting corticosteroids into the subacromial space is one method to treat inflammation and pain. Injections can reduce pain and inflammation and restore the mobility of shoulder joints. Injections into the subacromial space also are administered in the following conditions:
- Subacromial bursitis: Inflammation of the bursa (small fluid-filled sac) found near joints.
- Rotator cuff impingement syndrome: Injury to the muscles around the bones in the shoulder.
- Rotator cuff disorders: A tear in tendons (tissue connecting the muscle to bone) around the shoulder joint.
- Adhesive capsulitis: A condition characterized by stiffness and pain in the joints.
- Rotator cuff tendinopathy: Swelling of the tendons in the shoulder.
Subacromial injections can be used as either a treatment or diagnostic technique.
When should be shoulder subacromial injections avoided?
Subacromial injections should not be administered in the following conditions:
- Uncontrolled coagulopathy (impaired bleeding disorder)
- Cellulitis (overlying serious bacterial skin infection)
- Allergic to the contents of the injection
- Septic arthritis (infectious joint arthritis)
- Osteomyelitis (infection of the bone)
- Bedsores
- Less stable joints resulting in falls and injury
- Blood thinner use
- Diabetes mellitus
- Overlying skin bruise or wound
- Young age
- Unable to remain still for the procedure
How is a shoulder subacromial injection administers?
The patient is made to either stand or sit. The physician identifies the subacromial space by examining it. Once the physician identifies the subacromial space, a syringe filled with steroid and a local anesthetic is injected into the joint space. The solution should enter the space with minimal resistance. The physician may reposition the needle in case of any resistance. The ultrasonographic technique can enhance the accuracy of the subacromial injection. It may take two-seven days for the steroid medication to provide pain relief.
This technique offers temporary relief of pain and inflammation. Shoulder pain that does not respond to subacromial injections needs to be treated with surgery.
What are the complications of a shoulder subacromial injection?
The complications of a subacromial injection include:
- Allergic reactions to the anesthetic agents
- Infection at the site of injection
- Rupture of blood vessels and nerve
- The increased blood sugar level in patients with diabetes
- tendon (a tough band of tissue connecting the muscle to the bone) rupture
- Reddening of skin
- Light patches on the skin
- Steroid-induced joint inflammation
- Loss of fatty tissue
- Steroid-induced side effects
- Steroid flare-up (pain and inflammation around the site of injection)
- Muscle wasting
- Skin discoloration
Other possible rare side effects of the subacromial injections are
- bruising,
- bleeding and
- pain at the injection site for some days.
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