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Subcoracoid Bursa Injection

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Other Names

  • Subcoracoid Bursa Injection

Background

Illustration of the subcoracoid bursa (blue) relative to the subscapularis muscle and conjoined tendons of coracobrachialis and biceps tendons. Note the subcoracoid recess is also labeled in blue (as SSR=subscapularis recess)[1]

Key Points

  • Use a high frequency linear transducer
  • A 25g, 1 inch needle is sufficient in most patients
  • This procedure can be used diagnostically
  • The arm should be in external rotation

Anatomy of the Subcoracoid Bursa

Palpation vs Ultrasound Guidance

  • Comparison of palpation guidance and ultrasound guidance has not been made in the literature

Indications


Contraindications

  • Absolute
    • Anaphylaxis to injectates
    • Overlying cellulitis, skin lesion or systemic infection
    • Septic Bursitis
    • History of Total Shoulder Arthroplasty
  • Relative
    • Can be treated with less invasive means
    • Tendon tear or rupture
    • Hyperglycemia or poorly controlled diabetes
    • Lack of symptom improvement with previous injection

Procedure

Subcoracoid bursitis during active external internal rotation
Ultrasound appearance of subcoracoid bursitis with arrow approach. (B=subscapularis Bursa, D=deltoid muscle, H=humerus, SS=subscapularis tendon<)[2]
Patient positioning for in-plane technique[2]

Equipment

  • Sterile prep (e.g. chloraprep, chlorhexadine, iodine)
  • Gloves
  • Needle: typically 25 gauge, 1 inch
  • Syringe: 5-10 mL
  • Gauze
  • Ethyl Chloride
  • Bandage
  • Injectate (e.g. Local anesthetic, Corticosteroid, etc)

Ultrasound Findings

  • Best visualized with a high frequency, linear transducer
  • Common ultrasound findings include:
    • May contain hypoechoic fluid collection
    • Passive internal/external rotation may cause bursal distension and pooling

Ultrasound Guided Technique

  • Position
    • Patient is supine
    • Elbow at side, shoulder is externally rotated
  • Needle orientation
    • In plane
    • Lateral to medial

Aftercare

  • No major restrictions in most cases
  • Can augment with ice, NSAIDS

Complications

  • Skin: Subcutaneus fat atrophy, skin atrophy, skin depigmentation
  • Painful local reaction
  • Infection
  • Hyperglycmia
  • Tendon, nerve or blood vessel injury

See Also


References

  1. Grainger AJ, Tirman PF, Elliott JM, Kingzett-Taylor A, Steinbach LS, Genant HK. MR anatomy of the subcoracoid bursa and the association of subcoracoid effusion with tears of the anterior rotator cuff and the rotator interval. AJR Am J Roentgenol. 2000 May;174(5):1377-80.
  2. 2.0 2.1 Malanga, Gerard, and Kenneth Mautner. Atlas of ultrasound-guided musculoskeletal injections. McGraw-Hill, 2014.
Created by:
John Kiel on 27 March 2023 15:10:00
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Last edited:
27 March 2023 15:50:19
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