Guna Collagen Medical Devices: Anatomical Injection Atlas for Practitioners

Part 3 of our Deep GUNA Research series on Collagen Medical Devices, for practitioners.

This article reproduces GUNA's own anatomical injection reference for its Collagen Medical Devices range. It is intended strictly for qualified medical practitioners already trained in periarticular, intra-articular, subcutaneous, intradermal and intramuscular injection technique, and is educational in nature — it does not replace formal clinical training, direct supervision, or a practitioner's own anatomical judgement in the individual patient in front of them. Guna Collagen Medical Devices must only be administered by a qualified medical practitioner. This article does not constitute instruction to perform these injections; it is a reference to GUNA's published technique for practitioners who are already qualified to do so.

This is the third and final article in our series on Guna Collagen Medical Devices. Part 1 covers what the devices are and the mechanism behind them; Part 2 is the complete product reference. This article sets out GUNA's anatomical injection atlas — the specific landmarks, needle gauge, depth and angle used region by region.

Standard Needle Specifications

Across the atlas, GUNA specifies three injection depths with consistent needle specifications:

• Subcutaneous (s.c.) or intradermal (i.d.) injections use a needle of 12–16mm length, 25–28G diameter. Subcutaneous injections are inserted at approximately a 45° angle; intradermal injections at approximately 30°.
• Intramuscular (i.m.) injections use a needle of 40mm length, 21G diameter, inserted at approximately 90°.
• Intra-articular (i.a.) injections vary by joint and are specified individually below, typically using a 22G needle.

Standard aseptic technique applies throughout: single-use gloves, iodine or alcohol solution for skin preparation, sterile gauze, and — for more sensitive intramuscular or intra-articular sites — a topical anaesthetic and ethyl chloride spray.

Elbow (MD-SHOULDER, MD-MATRIX, MD-MUSCLE, MD-NEURAL)

Point 1 (epicondylitis): 2–3cm distal to Point 2, with the elbow flexed at 90°, just in front of the epicondyle. Inject s.c. or i.d. — MD-SHOULDER + MD-MATRIX.

Point 2 (epicondylitis): midway point of the elbow crease, on the internal side of the biceps tendon. Inject s.c. or i.d. — MD-MATRIX + MD-TISSUE.

Point 3 (epicondylitis): elbow flexed at 90°, approximately 4cm in front of Point 2. Inject s.c. or i.m. at 5–6mm depth — MD-MUSCLE.

Point 4: posteroanterior aspect of the elbow, between the medial condyle of the humerus (trochlea) and the olecranon. Inject s.c. or i.m. at 5–6mm depth — MD-SHOULDER + MD-MATRIX.

Point 5: tip of the elbow, flexed at 90°. Inject s.c. or i.m. at 4–5mm depth — MD-MUSCLE.

Clinical use: De Quervain syndrome (stenosing tenosynovitis) — MD-SHOULDER + MD-NEURAL.

Cervical Region (MD-NECK)

Main points: 1. Below the external occipital protuberance, at the muscle insertion just below the transverse process of the atlas. Inject s.c. 2. 3–4cm lateral to the space between the spinous processes of C2 and C3. Inject s.c. 3. Series A–E, from the top: below the spinous processes of C2, C4, C5, C6 and C7 respectively. Inject i.d.

Secondary point: A) 3–4cm lateral to the space between C6/C7 (bilateral); B) 3–4cm lateral to the space between C7/T1; C) midway along the line joining the spinous process of C7 and the acromion. Inject i.m. at 5–6mm depth — MD-MUSCLE, or MD-NEURAL + MD-MUSCLE where pain radiates to the trapezius.

Clinical combinations: whiplash (MD-NECK + MD-NEURAL + MD-MUSCLE); postural neck ache (MD-NECK + MD-MUSCLE + MD-TISSUE); neck pain from cervical muscular trigger points (MD-NECK + MD-MUSCLE); stiff neck syndrome (MD-NECK + MD-MUSCLE); mechanical imbalance / facet joint syndrome (MD-NECK + MD-NEURAL); cervical spinal ligament syndrome (MD-NECK + MD-MATRIX + MD-NEURAL); cervical spinal nerve root pain (MD-NECK + MD-NEURAL).

Thoracic Region (MD-THORACIC)

Main points (A–H, from the top): below the spinous processes of T2, T3, T4/T6, T7, T8, T10, T11 and T12 respectively. Inject i.d.

Secondary points (A–E): 3–4cm lateral to the spaces between T2/T3, T3/T4, T7/T8, T10/T11, and T11/T12–L1 respectively. Inject s.c. — MD-MUSCLE + MD-NEURAL.

GUNA notes that numbering for the thoracic and adjoining regions starts from the vertebra prominens (C7) — "the most important landmark of the whole spine."

Clinical combinations: thoracic pain from cartilage-degenerative disorders / thoracic osteoarthritis (MD-THORACIC + MD-POLY); thoracic pain from scoliosis (MD-THORACIC + MD-NEURAL + MD-MUSCLE + MD-TISSUE); mechanical imbalance / costo-vertebral facet joint syndrome (MD-THORACIC + MD-NEURAL); thoracic spinal ligament syndrome (MD-THORACIC + MD-MATRIX); pain from thoracic long-muscle trigger points (MD-THORACIC + MD-MUSCLE); thoracic spinal nerve root pain (MD-THORACIC + MD-NEURAL).

Lumbar Region (MD-LUMBAR)

Main points (from the top): A) 3–6cm lateral to the space between L1/L2; B) 5–6cm lateral to L2/L3; C) 5–6cm lateral to L3/L4; D) 5–6cm lateral to L4/L5; E) 3–4cm lateral to L5/S1. Inject i.m. or s.c. at 10–12mm depth.

Anatomical landmarks (A–D): below the spinous processes of L2, L3, L4 and L5 respectively. Inject i.d. or s.c.

Secondary point: A) the iliac crest, approximately 8–10cm from the posterior midline; B) the middle of the gluteus maximus, on the same line as landmark A. Inject i.m. at 8–10mm depth — MD-MUSCLE + MD-TISSUE, or MD-MATRIX + MD-ISCHIAL.

Clinical combinations: lumbar pain from cartilage-degenerative disorders / lumbar or lumbosacral arthrosis (MD-LUMBAR + MD-POLY); lumbar/lumbosacral mechanical imbalance (MD-LUMBAR + MD-NEURAL); sacro-iliac syndrome (MD-LUMBAR + MD-MATRIX); low-back pain from musculo-tendinous trigger points (MD-LUMBAR + MD-MUSCLE); postural low-back ache (MD-LUMBAR + MD-MUSCLE + MD-TISSUE); spinal lumbar/lumbosacral nerve root pain (MD-LUMBAR + MD-NEURAL + MD-ISCHIAL).

Ischial Nerve (MD-ISCHIAL)

Main points: A) midway of the gluteus maximus, 3–6cm lateral from the posterior midline; B) midway of the gluteal-femoral fold; C) midway of the posterior thigh, between landmarks B and D. Points A–C inject i.m.

D) the point of intersection between the gastrocnemius and soleus tendons (the crease behind the popliteal crease) — inject i.d. E) 3–4cm from the tip of the lower, posterior external malleolus — inject s.c. F) midway of the popliteal fossa — inject s.c.

Secondary points: A) midway of the anterior thigh, ~20cm above the upper edge of the patella; B) midway of the thigh, ~15cm above the patella; C) with the patient standing, the point on the lateral thigh touched by the middle finger. Inject i.m. or s.c. — MD-NEURAL + MD-MATRIX.

Clinical combinations: sciatic pain (MD-ISCHIAL alone); lumbar-sciatic pain (MD-ISCHIAL + MD-LUMBAR + MD-NEURAL); persistent sciatic pain following surgical treatment of disc herniation at L4–L5/L5–S1 (MD-ISCHIAL + MD-NEURAL); nerve pain in the lower lumbar spine (MD-ISCHIAL + MD-NEURAL + MD-MUSCLE); Morton's neuroma (MD-ISCHIAL + MD-NEURAL + MD-TISSUE).

Shoulder (MD-SHOULDER)

Main points: 1. The lateral-external surface of the shoulder, at the acromioclavicular joint, in the dimple formed when the arm is lifted. Inject s.c., i.d. or i.a. 2. Midway along the line joining the acromioclavicular joint to Secondary Point A. Inject s.c. 3. With the upper limb horizontal, the posterior-external surface, in the dimple between the acromion and the humeral tuberosity. Inject as a periarticular injection at 90°, close to the skin surface, near the joint capsule (alternatively s.c.). 4. The glenohumeral joint itself can be approached from the anterior, lateral or posterior aspect — the posterior approach (via the dimple on the posterior aspect, along the vertical line through the posterior axillary fold) and the lateral approach are the most commonly used in ambulatory care.

Secondary points: A) the highest point of the axillary fold; B) the intersection between the muscle and supraspinatus muscle, posterior aspect of the acromion; C) 7cm lateral to the spinous process of C7; D) the highest point of the posterior axillary fold. Inject i.m. at 8–10mm depth — MD-MUSCLE + MD-NEURAL.

Clinical combinations: shoulder-arm polyarthritis (MD-SHOULDER + MD-POLY); rotator cuff syndrome (MD-SHOULDER + MD-MUSCLE); shoulder-arm syndrome (MD-SHOULDER + MD-NEURAL); frozen shoulder (MD-SHOULDER + MD-MUSCLE); shoulder pain from dislocation, alongside therapeutic rest (MD-SHOULDER + MD-NEURAL).

Wrist (MD-POLY, MD-SMALL JOINTS)

Secondary point: the external edge of the radius, proximal to the dorsal surface of the forearm, approximately 6–7cm from the flexion crease of the wrist. Inject s.c. — MD-POLY + MD-NEURAL.

Main points: 1. Dorsal surface of the forearm, approximately 2cm above the internal wrist, on the dorsal crease of the radius, hand supinated. Inject s.c. or i.d. 2. The internal border of the hand, in a dimple between the 5th metacarpal and the hamate bone. Inject s.c. 3. The radial depression, on the flexion crease of the wrist. Inject i.d. 4. 2cm above the flexion crease of the wrist, between the pisiform bone and the styloid process of the ulna. Inject s.c. 5. Midway along the flexion crease of the wrist. Inject s.c.

Clinical combinations: arthritis of the fingers at local painful points (MD-SMALL JOINTS + MD-NEURAL); rhizoarthrosis of the thumb / Forestier disease (MD-POLY + MD-NEURAL); carpal tunnel syndrome (MD-SMALL JOINTS + MD-NEURAL — see also the Elbow section above); De Quervain disease (MD-SMALL JOINTS + MD-NEURAL); rheumatoid arthritis of the hand (MD-SMALL JOINTS + MD-NEURAL + MD-MATRIX); hand tendon pain from prolonged immobilisation (MD-SMALL JOINTS + MD-MATRIX + MD-TISSUE).

Hip (MD-HIP)

Main points: A) with the patient standing, feet together, the posterior margin of the greater trochanter (or, with the patient lying on the unaffected side, the apex of the greater trochanter); B) 2cm above and in front of landmark A; C) with the patient standing, arm at the side, the point on the thigh touched by the tip of the middle finger.

For A and B: intra-articular injection, or alternatively intramuscular at 2cm depth with the needle angled toward the hip joint. For C: intramuscular at 1cm depth, needle at 90° to the skin surface.

Secondary point: 8cm above the external femoral condyle. Inject i.m. at 1cm depth, 90° to the skin (alternatively s.c.) — MD-MUSCLE.

The trochanteric bursa itself is located over the lateral prominence of the femur's greater trochanter; the standard approach uses a landmark 2cm below and anterior to the superior border of the greater trochanter, with a 22G needle inserted parallel to the floor and perpendicular to the femoral shaft.

Clinical combinations: hip joint osteoarthritis (MD-HIP alone); hip joint capsule inflammation (MD-HIP + MD-NEURAL); hip joint pain of nerve origin, including "burning hip" (MD-HIP + MD-POLY); hip joint pain of muscle origin (MD-HIP + MD-MATRIX + MD-TISSUE).

Knee (MD-KNEE)

Main points, anterior: A) the top margin of the patella, from 2cm above and 2cm to either side, following the curved edge of the patella; B) the infero-lateral margin of the patella, at the height of the joint line — inject s.c., or i.a. for the lateral side only.

Main points, posterior: C) and D) on the inner surface of the knee joint, at the height of the joint line, near the upper edge of the tibia. Inject at 5–6mm depth, 90° to the skin surface.

Secondary points: A) 4–5cm above the maximum convexity of the patella, injected i.m. at 6–10mm depth, 90° to the skin — MD-MUSCLE; B) the midpoint of the popliteal fossa, injected s.c. — MD-MATRIX.

For intra-articular injection, GUNA specifies a 5cm, 21G needle with the knee extended; the anterolateral and anteromedial approaches (knee flexed at 90°) are the two most commonly used sites.

Clinical combinations: knee arthrosis (MD-KNEE + MD-POLY); knee pain from rheumatoid arthritis or other autoimmune disease (MD-KNEE + MD-POLY); acute and chronic arthrosynovitis from injury, osteoarthritis or rheumatoid arthritis (MD-KNEE + MD-POLY); traumatic lesions of the cruciate or collateral ligaments (MD-KNEE + MD-POLY + MD-TISSUE); meniscal lesions and joint preparation ahead of meniscectomy (MD-KNEE + MD-POLY); post-surgical or post-traumatic arthrosynovitis (MD-KNEE + MD-MUSCLE); maintenance therapy after knee surgery (MD-KNEE + MD-MUSCLE + MD-NEURAL + MD-MATRIX).

Ankle (MD-SMALL JOINTS, MD-POLY)

Main points: 1. 2cm anterior and inferior to the external (lateral) malleolus, at the calcaneo-cuboid joint. Inject at 5mm depth, 90° to the skin. 2. The central extension fold of the foot (instep), immediately below the tibia. Inject at 5mm depth, 90° to the skin. 3. 1cm below and slightly behind the external malleolus, just above the heel. Inject at 5mm depth, 90° to the skin.

Secondary points: A) 2cm below and posterior to the medial malleolus, on the upper edge of the heel; B) the inner edge of the instep, 2cm anterior and inferior to the medial malleolus; C) the border between the scaphoid and the first cuneiform bone. Inject at 5mm depth, 90° to the skin — MD-SMALL JOINTS + MD-TISSUE.

Clinical combinations: arthrosis pain from hammer toe (MD-SMALL JOINTS + MD-POLY); metatarsal pain (MD-SMALL JOINTS + MD-POLY + MD-MATRIX); rheumatoid arthritis of the foot (MD-SMALL JOINTS + MD-POLY); foot tendon pain from prolonged immobilisation (MD-SMALL JOINTS + MD-POLY + MD-MATRIX); metatarsal pain with Morton's neuroma (MD-SMALL JOINTS + MD-POLY + MD-NEURAL).

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GUNA MD Diagram Point Reference by Anatomical Region

The table below consolidates the point-by-point reference above into a single quick-reference index, region by region.

Transcribed from the GUNA MD booklet. Items reading as uncertain in the source photographs should be verified against the original booklet.

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A Closing Note on Using This Atlas

Every landmark and depth above is reproduced exactly as GUNA publishes it, for practitioners already trained and qualified in these injection techniques. It is not a substitute for that training, for direct anatomical assessment of the individual patient, or for standard aseptic and safety practice — including checking for anticoagulant therapy, vessel fragility, or hypersensitivity before proceeding, as GUNA itself notes for several of the devices in this range. Where GUNA recommends it, a spot test injection monitored for one hour is a sensible precaution before full treatment.

This closes our three-part series on Guna Collagen Medical Devices. Together, the three articles cover the underlying theory and mechanism, the complete product reference, and this anatomical injection atlas.

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Related reading

• Guna Collagen Medical Devices: What They Are and How They Work
• The Complete Guna MD Collagen Device Reference for Practitioners

Source: GUNA, *Collagen Medical Devices* anatomical injection atlas reference.

Tags: Deep Guna Research, Guna Articles, Collagen Medical Devices, Injection Technique