1.  With the patient sitting on an exam stool, the clinician stands posterior to the affected scapula.

2.  Find the midpoint between the tip of the acromion and the medial aspect of the spine of the scapula, and mark it with an ink pen.

3.  Find the coracoid process, and mark it with an ink pen.

4.  Draw a line between these two points, and mark the midposition of this line.

5.  At that site, press firmly on the skin with the retracted tip of a ballpoint pen. This indention represents the entry point for the needle.

6.  After the landmarks are identified, the patient should not move.

1.  Prep the insertion site with alcohol followed by the povidone–iodine pads.

2.  Achieve good local anesthesia by using topical vapocoolant spray.

3.  Position the needle and syringe perpendicular to the skin with the tip of the needle directed toward the suprascapular notch.

4.  Using the no-touch technique, introduce the needle at the insertion site (Fig. 7.5).

5.  Advance the needle completely through the supraspinatus muscle and touch the bone of the suprascapular fossa. Back up the needle 1 to 2 mm.

6.  Aspirate to make sure that the needle tip is not in the suprascapular artery. If there is no blood return, then inject the steroid solution as a bolus into the muscle around the suprascapular nerve. The injected solution should flow smoothly into this area. If increased resistance is encountered, advance or withdraw the needle slightly before attempting further injection.

7.  Following injection of the corticosteroid solution, withdraw the needle.

8.  Apply a sterile adhesive bandage.

9.  Instruct the patient to move his or her shoulder through its full range of motion in external rotation and abduction. This movement distributes the steroid solution throughout the suprascapular fossa.

10.  Reexamine the shoulder and scapula in 5 min to confirm pain relief.