Who loves relocating shoulder dislocations as much as I do?
I know you do.
Often patients undergo procedural sedation in order to achieve adequate pain control and muscle relaxation. Alternatively or adjunctively, you can inject the shoulder joint with an anesthetic. Personally, I have had variable effectiveness with this technique. In cases of inadequate pain control, I always wonder if I was actually in the joint.
How can you improve your success rate in injecting into glenohumeral joint injection?
Trick of the trade:
Ultrasound guided shoulder injection
I found a great video on this technique, which is essentially a hematoma block in the joint. This screencasted talk is by Dr. Mike Stone (Highland Hospital) as part of his 2011 ACEP Scientific Assembly lecture on nerve blocks. Coincidentally, I ran into Mike at this week's UCSF Topics in Emergency Medicine course where he gave a talk on the use of ultrasound for the hypotensive patient. When I mentioned that I was going to highlight his shoulder injection trick on this blog, he whipped out his laptop and gave me the 6 minute portion of his ACEP talk. Wow, that was really nice of him.
To view his entire video on nerve blocks, check out the video here.
Things I learned about injecting the shoulder:
1. Use a spinal needle. A traditional needle often will not reach the glenohumeral joint.
2. You almost always get a flash of blood (hemarthrosis) when you are in the joint.
Also check out Dr. Stone's great ultrasound website called Point of Care:
http://pointofcare.blogspot.com/
I'm a fan.