Your source for pain medicine news and information on neuromusculoskeletal conditions, interventional pain procedures, orthopedic test videos, and journal article reviews
One video below.Click the black title link above (if you can’t see the video).
1) Left knee injection under fluoroscopy. It is important to note the “mustache sign” in which the contrast spreads to both sides of the joint on the A-P view. Also note the lateral fluoro view that shows contrast spread into the suprapatellar bursa — this is observed in 85% of adults as the septum becomes perforated during the 5th month of development. You will find fluid in the suprapatellar bursa with MRI and ultrasound in patients with knee joint effusion or bursitis. The image of the Baker’s cyst is great in that it shows that they are connected to the knee joint; they are especially common in patients with meniscal tears in which the knee has an effusion that leaks into the cyst and causes a fullness feeling in the back of the knee.
One video below.Click the black title link above (if you can’t see the video).
1) Right C4/5 intraarticular facet injection under fluoroscopic guidance - it is of particular importance to note the contrast spread. It should NOT blob up under the needle tip, but rather should spread out along the joint line and into the capsule recesses at either end (as it does in this video)
One video below.Click the black title link above (if you can’t see the video).
Left inadvertant deltoid muscle injection while performing a subacromial bursa injection under fluoroscopy. This shows the importance of ultrasound or fluoroscopic guidance while performing these injections, as more injections than we know may be in the deltoid muscle instead of the actual bursa or subacromial space when performing them “blind” (by palpatory landmarks alone).
Two videos below. Click the black title link above (if you can’t see the video).
Left glenohumeral injection using an approach to avoid the articular cartilage, but still get under the rather large joint capsule.
Left glenohumeral injection using an approach to enter the actual joint - Special thanks to Dr. Hazem Eissa for providing this second fluoroscopic video clip.
Video of a right L4 transforaminal epidural steroid injection. Note the spread of contrast both proximally and distally along the L4 nerve root. Click the black title link above (if you can’t see the video).
Special thanks to Dr. Hazem Eissa for providing this fluoroscopic video clip.
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