Intraarticular injection of the glenohumeral joint can be used to treat rheumatoid arthritis, inflammatory arthropathy, or adhesive capsulitis.
After informed consent is obtained, the patient is placed in the sitting position, with the shoulder internally rotated. The glenohumeral joint is palpated by placing the fingers between the coracoid process and humeral head. The joint space can be felt as a groove just lateral to the coracoid process. 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 1 fingerbreadth inferiorly and laterally to the tip of the coracoid process. The needle is directed in the anteroposterior plane just lateral to the coracoid process and is advanced into the groove. The needle is very gently manipulated through the joint capsule into the synovial cavity. Aspiration is attempted until the needle has entered the synovial space. If there is an effusion of the joint, the aspiration should be completed. After negative aspiration, or if the aspirated fluid is noninflammatory (clear and viscous), a 2- to 3-mL mixture of 20 mg triamcinolone acetonide (or equivalent) and local anesthetic should be administered (Fig. 67-36).
FIGURE 67-36. Glenohumeral joint injection aspiration and injection. (From Gatter RA. Arthrocentesis technique and intrasynovial therapy. In: Koopman WJ, ed. Arthritis and Allied Conditions: AA Textbook of Rheumatology. 13th ed. Baltimore, MD: Williams & Wilkins; 1997:753, with permission.)
Care is required not to direct the needle medially into the neurovascular structures in the axilla.
Hematoma and intravascular injection are possible, owing to the close proximity of the axillary vessels. If an arterial puncture occurs, prolonged direct pressure is usually adequate to prevent the development of a hematoma. Corticosteroids should not be injected if there is any suspicion that the joint is infected. If the fluid appears infected, it should be sent for culture and sensitivity and the patient treated appropriately for the infection.