1.  With the patient seated on the exam stool, the clinician stands or sits behind the affected scapula.

2.  Palpate to determine the area of most intense pain. This is usually along the medial superior scapular border of the scapula. Mark this site with an ink pen.

3.  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.

4.  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 at a 20-degree angle to the skin with the tip of the needle directed toward the area of tenderness in the scapulothoracic space.

4.  Using the no-touch technique, introduce the needle at the insertion site (Fig. 7.7).

5.  Advance the needle into the point of maximal tenderness in a plane parallel to the undersurface of the scapula, not toward the chest wall.

6.  Inject half of the steroid solution as a bolus at the point of maximal tenderness and the remainder in the scapulothoracic space. The injected solution should flow smoothly into the space. 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. This movement distributes the steroid solution throughout the area.

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