You know where you can stick that … or do you? Where to inject the deltoid and why
The COVID-19 pandemic has seen a huge increase in the number of intramuscular injections into the deltoid being administered. Alan Walker provides an overview of the anatomy of the deltoid and injection technique
Intramuscular injection into the deltoid muscle is the mainstay of current vaccination practice. The COVID-19 pandemic has seen a huge surge in the number of injections to be administered, and recruitment of vaccinators from more widely differing backgrounds than has been customary. Incorrect technique can cause injury, so this article summarises present knowledge of the at-risk structures, and proposes a method of injection that reduces hazards. It aims to improve the knowledge of vaccinators, and especially their trainers.
All of us will have a mental picture of the deltoid muscle, by far the most common site chosen for intramuscular vaccinations. We can envisage its triangular shape, the base arising from the bony outer edges of the shoulder girdle (clavicle, scapula), with its downward pointing tip attaching halfway along the lateral side of the humerus.
We know it to be powerful, enabling us to raise the arm out sideways from the chest wall. Underneath it lies a capsule enclosing the ball and socket shoulder joint, the bones themselves, and the muscles and tendons which perform its actions.
Directly under the deltoid itself, is a delicate fluid-filled pocket (the subdeltoid bursa), almost a secondary joint capsule, which permits these components to slip and slide effortlessly over one another (Codman, 1984).
All of these structures under this muscle have been injured from time to time as a result of vaccinations, and damage to the shoulder mechanism can be very debilitating, so taking steps to avoid injecting them seems logical (Barnes et al, 2012; Cook, 2015; Martín Arias et al, 2017). Figure 1 shows the left shoulder seen from behind.
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