Peritendinous injection of the bicipital tendon is a useful diagnostic and therapeutic procedure for bicipital tenosynovitis.
After informed consent is obtained, the patient is placed in the seated position with the arm externally rotated and lateral to the medial edge of the humeral head. The bicipital groove is located and the bicipital tendon palpated to determine the area of marked tenderness. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 1½-in. (4-cm), 21- to 23-gauge needle is inserted along the border of the bicipital tendon. A 6-mL mixture of 20 mg of triamcinolone acetonide (or equivalent) and anesthetic agent is injected 2 mL at a time at the point of maximal tenderness and 1 in. above and below this point along the border of the bicipital tendon sheath (Fig. 67-38).
FIGURE 67-38. Bicipital peritendonous injection. Approach for bicipital peritendonous aspiration and injection.
There should be no significant resistance encountered when injecting the tenosynovium. Resistance suggests that the tip of the needle is within the body of the tendon. Steroid injection into the tendon should be avoided.
Injecting directly into the tendon rather than into the peritendinous region may result in damage to the bicipital tendon.