Injections Around The Shoulder - Everything You Need To Know - Dr. Nabil Ebraheim
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- เผยแพร่เมื่อ 30 ม.ค. 2017
- Dr. Ebraheim’s educational animated video illustrates injection techniques of the shoulder rotator cuff muscles tear.
Injection of the shoulder could be part of the treatment of shoulder pain, especially if the pain is more than what the patient can handle.
Shoulder pain will probably hinder the progress of therapy.
Which patient is the one who we should inject?
1- Patient has pain with restricted shoulder movement.
2- Patient that has nighttime pain.
3- Patient cannot lie on the shoulder due to pain.
Injection is predominantly used for elderly patients with rotator cuff tears or patients with impingement syndrome.
Injection usually reduces the pain and inflammation.
It can be done either blind or ultrasound guided for injection around the shoulder itself.
If the injection being done is for the scapulothoracic joint, give the injection either fluoroscopic or blind.
The injection could be done by a posterior, lateral, or anterior approach.
I use the lateral and posterior approach.
The posterior approach is done 1-2 cm below the posterolateral acromion.
I mark the spot for the injection, then I introduce the needle and inject the fluid.
The blind injection usually not accurate.
Some of the data reports that the accuracy is between 65%-75% is probably not true (probably worse than that).
Make sure you do not inject the rotator cuff tendon itself with steroids.
When you do blind injection, you probably are injecting to the tendon and you do not know it because you cannot see the tip of the needle.
When you use ultrasound guidance, you must see the bursa and find the tip of the needle and distend the bursa.
You may do manipulation of the patient’s shoulder manually after administering the injection.
When do I give a blind injection?
I usually do blind injection the first time that I see the patient, especially if the patient is elderly or if the patient has an impingement syndrome.
I will use ultrasound guided injection when patient has severe pain and some restriction of shoulder movement, or if the patient has had previous shoulder surgery.
There are multiple points of pain, especially in the shoulder itself such as biceps tendon and AC joint.
I personally examine the patient before and after injection.
It is a very rewarding experience to see that the patient’s condition improved after ultrasound guided injection.
I usually inject steroids, 40 mg kenalog with about 10 mg lidocaine.
Cortisone will give short term yet, reasonable relief in some patients.
The numbing medication will cause the patient to feel less pain immediately.
However, the steroids can negatively affect the tendon and cartilage, causing tendon damage and rupture.
The shoulder is not flat.
The shoulder is a ball and socket joint and when you inject above the ball (humeral head), you are controlled by the shape of the ball.
You may be injecting the tendon despite any good intention of only injecting the subacromial area.
You may be unable to reach the area of the subacromial space due to the shape of the proximal humerus.
Even with ultrasound guidance, I still have to make multiple modifications to see that the needle actually in the bursa.
How many times do I give the patient an injection of steroids?
Usually about 3-4 times a year.
PRP: has a high level of concentrated growth factors which may help in healing the tissue.
A blood specimen is taken from the patient, centrifuged, and then platelet concentrate is obtained and activated before injected in the target area.
PRP: is probably good for young, active patients who play sports.
These patients may have partial or intrasubstance rotator cuff tears that causes pain which limits activity.
PRP may help these patients to avoid surgery and allow for healing of the rotator cuff tear.
PRP is usually injected with ultrasound guidance because we can’t afford to do this blindly.
We need to be able to see where the problem area is and inject the PRP into the area of this problem.
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Thank you for this illustrative video Dr. Ebraheim
Very helpful Dr Nabil. Thanks.
Thank you for clear explanation
Muchas gracias Doctor Ebraheim´s!
Very helpful, Doctor Ebraheim! Many sincere thanks!
Will Medicare or insurance cover PRP treatment? I hear it's very expensive.
Thank you, I was just looking for shoulder injections on your channel last week.
Thank you, it is really helpful
I am grateful to know what to expect thank you 🙏
This helps so much, thanks
always great ...
Thank You Sir for sharing your knowledge.
Thank you prof. Doctor for these excellent video .please doctor if you can upload some videos regarding how to use arthroscopy specially in kee and shoulder joints and basics of arthroscopy.thank you for every thing
GREAT INFORMATION
I appreciate you. your explanation is perfect and accurate.👋👍
Yes very helpful
Thank you kindly
Thanks doc!
Worst pain ever to get cortisone injection is in the shoulder didn’t start getting the pain until a couple hours later my doctor says it will last for 2-3 days!! I hope it really does. Can’t wait for this pain for be over feels like hell is in my shoulder can’t even sleep I have to sleep sitting down !!
😢 Cortisone shot on shoulder is very painful? Did it help you after 2-3 days of pain? I got frozen shoulder from past 45 days.
Thank you for your honesty
جزاكم الله خيرا د ابراهيم ❤
Thank you
Thanks a lot sir 😊
thank youuu
I’m in Physical Therapy and I had calcium deposit /tendinitis /tendinopathy and it’s too painful to do stretching I end up crying … then I go see my specialist doctor he said to it painful,,, He gave me cortisone shot and I rest home rest I don’t feel the pain ,,,Yaaay I got to sleep good ! Ur my doctor told me it’s temporary relief I got 4 more therapy to go… Thank you ur information
thanks
Thanks
thank u sir
I've not been able to build mussle in my left arm for years now I get like dead arm feels like all the time I hope this helps when I have mine
Very well explained - I would request you to please illustrate bit more in deep.
Thanks
Great
Just had my one how long till it works please it says rest but it don’t hurt please
How soon can i return to work after supraspinatus tendonitis ultra sound injection
Can your gp do this or will they refer for the ortho clinic to have it with ultrasound
Is it lidocain or lignocain? what is the percentage? and what about kenacort? Thank you
Sir do you use ultrasound by your self to locate bursa or you do with help of sonologist to help mark the bursa and then you inject the solution ?
Great video!! I m a family Med doc.. I m about to go do this.. it’s been a while so I needed a refresher.. will let you know how it goes :)
Del it inspires confidence that I found the best video on TH-cam ,when a doctor is using it as a refresher.
i will do it too. can you tell me how do you feel now?
🙄 Its been 4 yrs. Did u get your injection? Did it work for u? Any side effects?
From past 45 days im suffering frozen shoulder and advised ultrasound & mobilization. I attended only 2 sessions of therapy as i couldn't deal with day to day work with the increase in pain after therapy. But without therapy also the pain is continuously increasing.
What do u advice me?
@teresa985 any update on your situation?
How long recovery post cortisone + injection + prp ?
Sir my shoulder injured 1 year before... now i will take this injection ..itz work???
Tell me when the pain goes away....
It doesn't it gets worse!the only relief you get is the numbing medicine thats all !bill
Thank you doctor. Very informative video. Can I receive PRP Injection along with steroid? Thanks
Can PRP be injected without US guidance? Why we ca
n't afford it?
Try using non-preservative (methyl paraben) xylocaine, you get no precipitate in the syringe if you use non -preservative xylo).
🙄 What r u saying?
I got frozen shoulder. You got any advice for me?
I got an appointment for that in a couple days I don’t know which one I’m getting kinda scared now🥺
how did it go?
Update?
Hurts like hell, had my injection today,made me well cry 😂😂
Clarebear1973 Cooper how are you today? Both of my shoulders hurt all day. Seeing my doctor in a week. Thank you.
I’m late to the party but I just had two injections done the other day for bursitis or tendinitis and I’m glad I didn’t know how bad it would hurt before going in. The pressure was so bad, and for about an hour after, any movement hurt really bad. It subsided but I was worried that I was being a baby 😂
@@frooostedflakes4133How do you feel now? Does it work?
@@Xouiso I can't believe it's already been 9 months! The injections helped and fixed the problems with the pain, but it didn't fix any of the shifting and popping as well as the pain that comes with that. I had to get an MRI where they had to inject me AGAIN with contrast lol. They found fraying in my labrum and there's a lot of instability which I'll get surgery to fix at some point. Thank you for checking in! All this started after having a vaccine administered incorrectly :(
@@frooostedflakes4133 Thank you for reply.2 years ago I injured my one of the shoulder. Although It was not a complete tear, i have several conditions in my both bicep tendon and two rotator cuff tendons. I was thinking to get shots but it seems they only mask the pain. I need pain free function to return back to sport.
frozen shoulder i got my first shot yesterday but still in so munch pain and cant move it on my own
Was the injection done in front or back of shoulder? Was it super painful?
How is your shoulder now?
@@lukeskywalker1840 I’ve had multiple injections from rheumatologists and orthopedic doctors. The ultrasound guided injection last the longest and is the least painful. It is very cool and informative to watch the needle go into the bursa. The orthopedic dr injects blind into the back of the shoulder. This hursts like heck. I’m due for one in a few weeks. I am being treated for a fractured humerus which is starting to freeze. I’m going to ask for guided ultrasound I doubt he’ll do it though. I have learned on my own how to do trigger point injections into the muscle using 2% xylocaine it is preservative free and really gives me a few days of pain relief when I am suffering terrible pain with limited range of motion.
Will this help with a slap tear
dealing with the same...howd yours go?
Who can perform this? Orthopedic?
The answer is no not need an orthopedic
Can you use PRP for other joints the SI joint?
Jake Pham try Prolotherapy
Jake Pham try prolozone before Prolotherapy
10ml?????
Inshjectshon ov sha showlder
I'm watching this video as my shoulder Bursa is extremely limited in movement.
While sleeping in no way can I lay on the shoulder in question.
I'm thinking I may need to bite the bullet and get an injection. 😲😲
Hi, Did you get an injection? It’s helping?
Sir, I am 40 and have a shoulder injury of 15 years old. The present MRI has found it grade 3 partial tear.. My doctor advised me for the cortisone shot.. Shall i go for it.... Does it have any side effect.. Will it repair the tear.. Is it a permanent solution...plz reply me
Did you get the shot in your shoulder?
same situation, the shots are abandaid for me not a cure, how did it go for you, are you going for surgery options or did the shots help you (along with PT/massage therapy, ..)
Why does he not reply? 😒
Plz anyone reply , i have the same problem of type 3. I'm confused whether I should go for Injection or Surgery?
Had an injection today…no pain during….
Really?
You took injection for what condition? It wasnt painful? Was it helpful later?
My mom just got a rotator cuff cortisone shot yesterday. Is it normal that the doctor did not only inject to a single site but instead multiple sites? The needle punctured the skin once but he proceeded to inject the cortisone in multiple areas around the site? I’m seeing many videos and many of these shots are injected to just a single site. I’m questioning if this Doctor just wanted to inflict unnecessary pain on my mom. (He seemed upset after I asked him to put a mask on before performing the injection since we are in a pandemic. Although he put one on, it was improperly worn, only covered mouth not his nose. He shared his belief that Covid is just a hoax. Ridiculously to hear from a Doctor during times like these). Any help would be appreciated.
I hope you’re trolling bro. If you’re doctor said Covid is fake u should’ve left u idiot 😂
@@Mak2Grim I appreciate the time you took to comment although I found it to be a waste of your time if your intention was to sound like a douche on a serious subject. Of course we got rid of the doctor immediately.
From past 45 days im suffering frozen shoulder & a bit naive in this regard & trying to understand my situation. You got any advice for me regarding cortisone shot? Did it help your mother?
Im advised ultrasound & mobilization. I attended only 2 sessions as it became more painful but even without physiotherapy the pain still keeps increasing.
Do i go back to the Doc or go back for physiotherapy? Mobility is restricted & painful.
Thanks