Scapulothoracic Bursa Injection



Scapulothoracic Bursa Injection


Donald V. La Barge, III, MD










Graphic shows the relationship of the shoulder girdle to the thorax. The scapulothoracic bursa lies between scapula and ribs, necessitating oblique fluoroscopy and shoulder abduction to access the bursa.






Anteroposterior fluoroscopic spot radiograph illustrates needle placement image between scapula and ribs image during scapulothoracic bursa injection. Note medial border of scapula image.


TERMINOLOGY


Abbreviations



  • Scapulothoracic bursa (STB)


Definitions



  • Injection of corticosteroid and long-acting anesthetic into a bursa for diagnosis and treatment of bursitis


PRE-PROCEDURE


Indications



  • Pain related to scapulothoracic bursa



    • Subscapular pain and crepitus with scapulothoracic motion


Contraindications



  • Coagulopathy


  • Local or systemic infection


  • Relative



    • Iodinated contrast allergy


    • Pregnancy


Getting Started



  • Things to check



    • Pre-procedure imaging



      • Look for other more likely causes of pain (rotator cuff injury, shoulder impingement, etc.)


    • Coagulation parameters


    • Informed consent


  • Medications



    • Corticosteroid


    • Long-acting anesthetic


    • Short-acting (local) anesthetic


    • Iodinated contrast (if not contraindicated)


  • Equipment list



    • Radiopaque marker


    • Sterile prep and drape materials


    • 5 mL syringe and 1.5 inch 25-gauge needle for local anesthetic


    • 5 mL syringe and extension tubing for radiographic contrast


    • 3 mL syringe for injectate


    • 22-gauge spinal needle for injection


    • Hydrogen peroxide


    • Bandage


PROCEDURE


Patient Position/Location



  • Best procedure approach



    • Prone



      • Symptomatic side arm up with hand near head



        • If not tolerated, move arm to side and increase C-arm angulation to visualize subscapular space


      • Place marker on skin at point of maximal tenderness along medial border of scapula


Equipment Preparation



  • May need tape or restraint to keep patient’s arm near head


  • Draw 5 mL local anesthetic, and attach 1.5 inch 25-gauge needle


  • Draw 5 mL iodinated contrast, and attach extension tubing



    • Tubing should be air-free


  • Draw corticosteroid and long-acting anesthetic


Procedure Steps



  • Procedure “time out”



    • Correct patient, site, and procedure


    • All necessary equipment is available


  • Angulate C-arm to look into scapulothoracic space along lateral rib cage



    • Lordotic view of ribs with rib closest to marker seen with anterior and posterior margins superimposed


  • Mark skin at nearest rib to point of maximal tenderness



    • Rib will serve as depth marker for needle insertion


    • Needle trajectory should be angled to pass beneath medial margin of scapula and hit rib at deep margin of scapulothoracic space


  • Perform sterile prep and drape


  • Create skin wheal with local anesthetic


  • Place 22-gauge spinal needle in subcutaneous tissues, and determine trajectory to targeted rib



  • Under intermittent fluoroscopy, advance needle beneath medial scapula border (parallel to scapula)

Sep 22, 2016 | Posted by in EMERGENCY RADIOLOGY | Comments Off on Scapulothoracic Bursa Injection
Premium Wordpress Themes by UFO Themes