A 69-year-old male had pain in his right shoulder for 2 months. Active abduction is impaired. Passive abduction was almost complete. One method of examining the range of rotation is by abducting the upper arm to 90 degrees, flexing the elbow 90 degrees, and performing rotations. On the left side the total range of rotarion is normal (180 degrees). On the right side external rotation is markedly impaired and internal rotation is slightly impaired. A mixture of methyl prednisolone and bupivacaine is injected into the joint. At first the coracoid process is located by palpation. The puncture site is about 1.5 cm lateral of its tip. A good method for reaching the joint cavity is to insert the needle into light bone contact against the head of the humerus while the upper arm is externally rotated, and let the tip of the needle enter the joint space while rotating the arm internally.
Restricted motion of the shoulder; intra-articular injection