Bicipital groove steroid injection

Biceps Tendon Sheath Injection - Lateral View

  • Mark the injection site with the pen tip in order to leave an impression in the skin — Point of maximal tenderness in bicipital groove.
  • Clean the skin thoroughly with as many alcohol swabs as needed (usually only one is needed).
  • Patient position: Lying supine with arm supinated
  • With the 25G needle/syringe, enter the skin going cephalad at a 20-30-degree angle .  If you enter tough, gritty tissue (biceps tendon), pull back a mm or two and redirect at a more shallow angle to get under the tendon sheath (of the long head of the biceps).
  • Aspirate to make sure you’re not in any vessel.
  • After negative aspiration, inject the full contents of the syringe.  Redirect or withdraw the needle slightly if it isn’t flowing easily (DO NOT INJECT UNDER PRESSURE — YOU’RE LIKELY IN THE ACTUAL BICEPS TENDON)
  • Withdraw the needle and apply band-aid.
  • Tips

    Radiologic evaluation to diagnose biceps tendinitis or tendinosis should begin with radiography of the shoulder to rule out primary causes of impingement ( Table 3 5 , 10 , 12 , 14 , 32 – 41 ) . Negative results on radiography should be followed by ultrasonography of the shoulder, which is the best method by which to extra-articularly visualize the biceps tendon. Suspected accompanying anatomic lesions may be seen with magnetic resonance imaging (MRI). 3 , 5 , 14 , 33 – 41 Many surgeons prefer obtaining MRI arthrography or computed tomography arthrography before surgery to visualize the intraarticular tendon and related pathology. If the patient demonstrates shoulder weakness and pain with an intact rotator cuff and labrum, electromyography should be performed to rule out a neuropathy. 3

    Bicipital groove steroid injection

    bicipital groove steroid injection

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