Lidocaine injection test for shoulder

The lidocaine injection test is used to exclude intrinsic glenohumeral joint pathology (eg, rotator cuff tear, frozen shoulder). To increase the space for needle insertion, the clinician may need to apply downward traction to the elbow. The point of entry is 1 to 1.5 inches (2.5 to 4 cm) below the midpoint of the acromion. The angle of entry parallels the acromion. A 1.5 inch (4 cm), 22-gauge needle is inserted to a depth of 1 to 1.5 inches (2.5 to 4 cm), and 1 mL of lidocaine is injected into the deltoid and 1 to 2 mL into the subacromial bursa.