Ultrasound-guided analgesic injection for acromioclavicular joint separation in the emergency department

We present the first documented case of an emergency clinician treating the pain of an acute Acromioclavicular (AC) joint separation through ultrasound (US) guided injection of an anesthetic agent. A 41 year old male presented with an acute traumatic grade III AC joint separation after falling off a scooter, and his pain was not significantly improved with oral medication. The AC joint was located by US, and bupivacaine was injected into the joint effusion under US guidance, yielding near complete resolution of pain. In orthopedics and physiatry literature, US guided AC joint injections have been shown to be far more efficacious than landmark guided AC joint injections, yet this is the first known case documenting injection in the Emergency Department (ED). The superficial location of the AC joint, its ease of identification by US, and the rapid onset of analgesia by intra-articular injection makes the US-guided anesthetic injection of the AC joint an ideal tool to incorporate into a multimodal approach to pain management in AC joint separations. (C) 2019 Elsevier Inc. All rights reserved.