Subcoracoid Bursa Injection

Other Names

• Subcoracoid Bursa Injection

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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)

• This page refers to injections of the subcoracoid bursa

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

• The subcoracoid bursa lies anterior to the subscapularis muscle
• It lies deep to the conjoined tendons of the coracobrachialis and short biceps tendons
• Does not communicate with the glenohumeral joint

Palpation vs Ultrasound Guidance

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

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Indications

• Subcoracoid Bursitis

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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

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Procedure

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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<)

Patient positioning for in-plane technique

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

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Aftercare

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

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Complications

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

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See Also

• Procedures Main
• Ultrasound Main
• Shoulder Pain Main

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