Technique: Lateral approach with fluoroscopic guidance. Note: I GREATLY prefer the A-P approach. Check it out HERE.
Patient position: Prone
Needle used: a 22-gauge 3.5″ quincke spinal needle is sufficient for most patients, although a 5″ may be needed for larger patients
- Prep and drape
- Use the fluoroscope to find the skin over the greater trochanter
- Make skin wheal and deeper anesthesia with local anesthetic (1% lidocaine) with 27- or 25-gauge needle at a spot 4-6cm cephalad to the greater trochanter
- With 3.5″ 22-gauge needle, enter the skin through the skin wheal and go towards the top of the greater trochanter (#1in the photo)
- This will tell you you’re in the correct coronal plane
- Redirect the needle and aim towards the femoral head/neck junction (#2in the photo)
- Do NOT try to inject between the femoral head and the acetabulum
- Inject contrast to confirm intraarticular flow
- You should be looking for the circular pattern noted in the fluoroscopic image below
- Inject the corticosteroid or steroid/local anesthetic injectate
- Remove needle. Place band-aid. Patient can go home immediately, with instructions to take it easy with that hip for 3-5 days.