Acromioclavicular Joint Injection

==Anatomy==
The ACJ is a small joint therefore the injected volume should reflect this i.e maximum 2mL.
==Indications==
*pain - arthropathy i.e. osteoarthritis
*diagnostic injection
==Contraindications==
* Absolute: anaphylaxis to contrast/ injectates, active local/ systemic infection 
* Relative: bleeding diathesis, recent injection with steroid in same/other body parts, unable to remain still for the procedure, young age
==Technique==
;Equipment
* ultrasound machine, sterile probe cover and a skin marker (ultrasound)
* skin marker, a metal rod for marking and short connecting tube (fluoroscopy)
* skin cleaning product
* sterile drape
* sterile field and tray for sharps
* syringe selection i.e. 5mL and 3mL (US)
* larger bore drawing up needle
* needle to administer local anaesthetic i.e. 30 or 25-gauge needle
* needle to cannulate the joint i.e. 25 or 27-gauge needle
* injectants i.e. local anaesthetics, iodinated contrast, corticosteroid preparation
* sterile gauze
* adhesive dressing
===Landmark Guided===
===Ultrasound Guided===
File:ACJ joint US longitudinal.jpg|Longitudinal
File:AC Joint US transverse.jpg|Transverse
File:AC joint US transverse2.jpg|Transverse
;In plane
* optimise patient positioning by lying them flat and supine on the bed for cranial access, or at 45 degrees for anterior access
* identify ACJ in the transverse plane; perpendicular to the clavicle, and optimise imaging and mark skin entry point
* clean skin and draw up appropriate medications
* consider local anaesthesia along the proposed needle path
* under ultrasound guidance using anterior or cranial access, insert the needle in-plane with the probe into the ACJ
* administer arthrogram injectate under direct visualisation
* remove needle and apply dressing/ band-aid as required
;Out of plane
* optimise patient positioning by lying them flat and supine on the bed or at 45 degrees, the joint will be accessed cranially
* identify the ACJ in a longitudinal plane; parallel to the clavicle, with the ACJ in the centre of the image. Optimise imaging and mark skin at the probe midpoint
* clean skin and draw up appropriate medications
* consider local anaesthesia along the proposed needle path
* under ultrasound guidance using cranial access, insert the needle at the probe midpoint and out-of-plane with the probe into the ACJ
* administer arthrogram injectate
* remove needle and apply dressing/ band-aid as required
===Fluoroscopy Guided===
* optimise patient positioning by lying them supine on bed, the joint is accessed anteriorly
* optimise imaging field and using the metal rod, mark the skin at the target entry at the midpoint of the joint
* clean skin and draw up appropriate medications
* consider local anaesthesia along the proposed needle path
* under fluoroscopic guidance using anterior access, insert a needle into the ACJ
* check for an intra-articular needle tip position with a small amount of iodinated contrast via connection tubing and save a post injection image
* administer arthrogram injectate
* remove needle and apply dressing/ band-aid as required
==Complications==
Steroid flare is a relatively common side effect which will settle after 1 or 2 days. The most serious complication is infection causing septic arthritis. Steroid containing injections should be postponed if there are any signs and/or symptoms of local and/ or systemic infective. Fat necrosis causing skin dimpling and skin discolouration can occur due to steroid leaking into the surrounding soft tissues
==Aftercare==
==Videos==
==External Links==
==References==
Category:Infoboxes
Category:Partially complete articles
Category:Shoulder Procedures