Restricted Motion of the Shoulder; Intra-Articular Injection

A 69-year-old male had pain in his right shoulder for 2 months and lately it was also aching in the night. Active abduction is impaired on the right side. Passive abduction was almost complete. One method of examining the range of rotation is by abducting the upper arm to 90 degrees, flexing the elbow 90 degrees, and performing rotations. On the left side the total range of rotarion is 180 degrees. On the right side external rotation is markedly impaired and internal rotation is slightly impaired.

At first the coracoid process is located by palpation. The puncture site is about 1.5 cm lateral of its tip. In frozen shoulder, joint-space narrowing often occurs, and the correct location of injection should be confirmed with an ultrasonic device.

The puncture site is thoroughly cleansed. A good method for reaching the joint cavity is to insert the needle into light bone contact against the head of the humerus while the upper arm is externally rotated, and let the tip of the needle enter the joint space while rotating the arm internally. A mixture of anaesthetic agent and methyl prednisolone is injected into the glenohumeral joint. The puncture site is covered with a self-adhesive sterile dressing, and it should not be allowed to get wet on the puncture day.

Restricted Motion of the Shoulder; Intra-Articular Injection