Subacromial bursa

The advisability of corticosteroid injection into the glenohumeral joint of patients with rotator cuff pathology is debated. Some authors prefer not to inject the drug in patients with partial-thickness tears of the rotator cuff to prevent progression of tendon damage. Others believe that injection inside the subacromial bursa can be rather safe in these circumstances. 

Fig. 18.14a-f. US-guided treatment of calcifying tendinitis aspiration irrigation technique. Schematic drawings illustrate the standard sequence of a two-needle procedure, a Under real-time US observation, lidocaine is injected within the subacromial bursa (asterisk) by the first 18 gauge needle. The needle path should point toward the rotator cuff (rc) calcification (star) to be treated, b The same needle is advanced (black arrows) until its tip penetrates the calcification, c A second 20 gauge needle is inserted (black arrows) within the calcification. With this needle, multiple passages within the calcification and rotational movements are performed, d Injection (open arrows) of saline and lidocaine by the second needle and aspiration by the first needle is then performed in an effort to remove as much calcified material as possible, e When a substantial amount of calcium has been washed out, steroids are injected (open arrow) into the subacromial bursa to treat inflammation secondary to diffusion of calcium into the bursa. Then the needles are withdrawn (black arrows), e At the end of the procedure, residual calcific deposits remain within the tendon... 

Biceps Tendon and Rotator Cuff 210 Long Head of the Biceps Tendon 210 Subscapularis Tendon 214 Supraspinatus Tendon 216 Infraspinatus and Teres Minor Tendons 223 Rotator Cuff Interval 226 Shoulder Beyond the Cuff 227 Glenohumeral Synovial Space 227 Subacromial Subdeltoid Bursa 229... 

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