The landmarks for subacromial injections are the acromion, the humeral head and the coracoid process.
1. Start off by identifying the postlateral corner of the acromion and the coracoid process (Figure 1).
2. Identify the soft spot approximately 2 cm medial and inferior to the postlateral edge of the acromion. This is the landmark for entering the subacromial joint (Figure 2).
3. Palpate the soft spot and the coracoid process between the thumb and index finger. This will give you the “line” with which to approach the subacromial space (Figure 3)
4. By aligning your syringe and needle with the “soft spot” and coracoid process, you will be able to enter and infiltrate the subacromial joint easily. There should be no resistance to flow and the patient should be comfortable throughout the procedure (Figure 4).