• Jennifer Kelly McDonald
  • Philip PengEmail author


With a lifetime prevalence of 70%, shoulder pain is commonly encountered in the pain practice. The shoulder consult can be formidable due to the multiple potential pain generators. This chapter reviews the relevant anatomy of the shoulder girdle and the most common pathology leading to shoulder pain. The reader is guided to identify the most likely pain generator using key features on history and physical examination. A stepwise approach is provided to the ultrasound scanning of the long head of biceps tendon, rotator interval, subacromial subdeltoid bursa, posterior glenohumeral joint, and acromioclavicular joint. Proper needle placement and injection technique is depicted for the posterior glenohumeral joint, acromioclavicular joint, subacromial subdeltoid bursa, long head of biceps tendon, and the anterior glenohumeral joint via the rotator interval.


Shoulder joint Shoulder pain Glenohumeral joint Acromioclavicular joint Rotator cuff Bursitis Subacromial bursa Biceps tendon Subacromial impingement Frozen shoulder Injection Rotator interval Adhesive capsulitis 





coracohumeral ligament




greater tuberosity


hyaluronic acid


long head of biceps


lesser tuberosity


randomized control trial


subacromial subdeltoid


superior glenohumeral ligament


transverse humeral ligament



Suggested Reading

  1. Cadogan A, Laslett M, Hing WA, McNair PJ, Coates MH. A prospective study of shoulder pain in primary care: prevalence of imaged pathology and response to guided diagnostic blocks. BMC Musculoskelet Disord. 8 ed. BioMed Central. 2011;12(1):119.CrossRefGoogle Scholar
  2. Crawshaw DP, Helliwell PS, Hensor EMA, Hay EM, Aldous SJ, Conaghan PG. Exercise therapy after corticosteroid injection for moderate to severe shoulder pain: large pragmatic randomised trial. BMJ. BMJ Publishing Group. 2010;340(jun28 1):c3037–7.Google Scholar
  3. Di Giacomo G, de Gasperis N. Hyaluronic acid intra-articular injections in patients affected by moderate to severe glenohumeral osteoarthritis: a prospective randomized study. Joints. 2017;5(3):138–42.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Hashiuchi T, Sakurai G, Morimoto M, Komei T, Takakura Y, Tanaka Y. Accuracy of the biceps tendon sheath injection: ultrasound-guided or unguided injection? A randomized controlled trial. J Shoulder Elb Surg. 2011;20(7):1069–73.CrossRefGoogle Scholar
  5. Hutchinson M, Brukner P, Khan K, Ben Clarsen, McCrory P, Cools A, et al. Brukner & Khans clinical sports medicine injuries. McGraw-Hill Education; 2017. 1 p.Google Scholar
  6. Izquierdo R, Voloshin I, Edwards S, Freehill MQ, Stanwood W, Wiater JM, et al. American academy of orthopaedic surgeons clinical practice guideline on: the treatment of glenohumeral joint osteoarthritis. J Bone Joint Surg Am. 2011;93(2):203–5.CrossRefPubMedGoogle Scholar
  7. Koester MC, Dunn WR, Kuhn JE, Spindler KP. The efficacy of subacromial corticosteroid injection in the treatment of rotator cuff disease: a systematic review. J Am Acad Orthop Surg. 2007;15(1):3–11.CrossRefPubMedGoogle Scholar
  8. Peck E, Lai JK, Pawlina W, Smith J. Accuracy of ultrasound-guided versus palpation-guided acromioclavicular joint injections: a cadaveric study. PM R. 2010;2(9):817–21.CrossRefPubMedGoogle Scholar
  9. Peng PWH, Cheng P. Ultrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures. Part III: shoulder. Reg Anesth Pain Med. 2011;36(6):592–605.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Rashid A, Kalson N, Jiwa N, Patel A, Irwin A, Corner T. The effects of pre-operative intra-articular glenohumeral corticosteroid injection on infective complications after shoulder arthroplasty. Shoulder Elbow. SAGE PublicationsSage UK: London. 2015;7(3):154–6.CrossRefGoogle Scholar
  11. Rockwood CA Jr, Matsen FA III, Wirth MA, Lippitt SB, Fehringer EV, Sperling JW. Rockwood and Matsen’s the shoulder: Elsevier Health Sciences; 2016. 1 p.Google Scholar
  12. Rutten MJCM, Collins JMP, Maresch BJ, Smeets JHJM, Janssen CMM, Kiemeney LALM, et al. Glenohumeral joint injection: a comparative study of ultrasound and fluoroscopically guided techniques before MR arthrography. Eur Radiol. Springer-Verlag. 2009;19(3):722–30.CrossRefGoogle Scholar
  13. Sabeti-Aschraf M, Lemmerhofer B, Lang S, Schmidt M, Funovics PT, Ziai P, et al. Ultrasound guidance improves the accuracy of the acromioclavicular joint infiltration: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc. Springer-Verlag. 2011;19(2):292–5.CrossRefGoogle Scholar
  14. Schaeffeler C, Brügel M, Waldt S, Rummeny EJ, Wörtler K. Ultrasound-guided intraarticular injection for MR arthrography of the shoulder. Rofo. © Georg Thieme Verlag KG Stuttgart · New York. 2010;182(3):267–73.Google Scholar
  15. Wu W-T, Chang K-V, Han D-S, Chang C-H, Yang F-S, Lin C-P. Effectiveness of glenohumeral joint dilatation for treatment of frozen shoulder: a systematic review and meta-analysis of randomized controlled trials. Sci Rep. Nature Publishing Group. 2017;7(1):10507.Google Scholar
  16. Xiao RC, Walley KC, DeAngelis JP, Ramappa AJ. Corticosteroid injections for adhesive capsulitis: a review. Clin J Sport Med. 2016.Google Scholar
  17. Zhang J, Ebraheim N, Lause GE. Ultrasound-guided injection for the biceps brachii tendinitis: results and experience. Ultrasound Med Biol. 2011;37(5):729–33.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.The Ottawa Hospital, Physical Medicine and Rehabilitation, The Ottawa Hospital Rehabilitation CentreOttawaCanada
  2. 2.Department of Anesthesia and Pain ManagementToronto Western Hopsital and Mount Sinai Hospital, University of TorontoTorontoCanada

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