Subscapular Injection

Cortisone Subscapular Injection is used as a treatment method in case of Subscapular chronic tendinitis or bursitis.

Equipment Needed

In case of Subscapular Bursa Injection:

1. 2 ml Syringe
2. Blue, 23 gauge needle
3. 20 mg of (Kenalog 40)
4. 1.5 ml, Lidocaine 2%
5. Total volume injected is 2ml.

In case of Subscapular Tendon Injection:

1. 1 ml Syringe
2. 1.25 inches (30 mm) needle
3. 10 mg of (Kenalog 40)
4. 0.75 ml, Lidocaine 2%
5. Total volume injected is 1 ml

Related Anatomy

The subscapularis tendon inserts into the medial edge of the lesser tuberosity of the humerus. It is approximately two fingers wide at its teno-osseous insertion and is a thin fibrous structure that feels bony to palpation. The subscapularis bursa lies deep to the tendon in front of the neck of the scapula and usually communicates with the joint capsule of the shoulder. It is invariably extremely tender to palpation, even when not inflamed.

See Also: Rotator Cuff of the Shoulder

Subscapular Injection Technique

• Patient sits supported, with arm by the side and held in 45 degrees lateral rotation
• Identify coracoid process. Move laterally to feel small protuberance of lesser tuberosity while passively rotating the arm. Mark medial aspect of tuberosity
• Insert needle at this point, angling slightly laterally and touching bone at tendon insertion, or in the sagittal plane through tendon to enter bursa
• Pepper solution into tendon insertion or as a bolus deep to tendon into bursa.

Aftercare

Relative rest for a week is advised, with a progressive stretching and rotator cuff strengthening programme when the patient is pain free. In sporting overuse injuries, the cause should also be addressed.

Practice point

Subscapularis bursitis and tendinitis are often difficult to differentiate. The bursa is implicated if there is more pain on the scarf test than on resisted medial rotation and if there is more than usual tenderness to palpation. If the bursa and tendon are inflamed together, they can both be infiltrated at the same time by peppering the tendon first and then going through it to infiltrate the bursa. The total dose is increased to 30 mg in a total volume of 3 ml.