Acromioclavicular Joint Injections Technique

Updated: Apr 06, 2017
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Erik D Schraga, MD  more...
  • Print
Technique

Injection Into Acromioclavicular Joint

To locate the acromioclavicular (AC) joint line, palpate the acromion from the lateral edge medially until it meets the clavicle. Alternatively, follow the clavicle laterally until it meets the acromion. At the lateral edge of the clavicle, a bony rim lies 2 cm medial from the joint line. At the articulation of the acromion and clavicle, a slight depression is usually evident; this depression indicates the joint line. [7]

After the medial edge of the acromion and the distal edge of the clavicle are palpated and the AC joint has been accurately identified, attach a 25-gauge needle to a 3-mL syringe that contains the solution of local anesthetic and steroid.

Inject into the joint space using a superior and anterior approach. The injectate should enter the space smoothly and with minimal resistance. If resistance is encountered, reposition the needle. To further open the joint space, the patient’s arm can be pulled into full lateral rotation. (See the video below.)

Patient (48-year-old woman with preexisting acromioclavicular [AC] joint arthritis), was hit by motor vehicle, which exacerbated her AC joint arthritis. Video courtesy of James R Verheyden, MD.

Some studies have suggested that the use of ultrasonographic guidance may enhance the accuracy of AC joint injection. [8, 9, 10, 11]

Next:

Complications

Complications of AC joint injection include the following:

Rare but possible complications include the following:

  • Systemic effects of the steroid
  • Elevated blood sugar levels (in patients with diabetes)
  • Tendon rupture
  • Hypopigmentation of the skin
  • Facial flushing
  • Steroid arthropathy
  • Fat atrophy
  • Muscle wasting
  • Steroid flare reaction
Previous