Name:
Fluoroscopic Shoulder Hydrodilatation for Frozen Shoulder
Description:
Fluoroscopic Shoulder Hydrodilatation for Frozen Shoulder
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/8a338f3b-a6da-4e26-b358-efba3bf15c33/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H05M00S
Embed URL:
https://stream.cadmore.media/player/8a338f3b-a6da-4e26-b358-efba3bf15c33
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/8a338f3b-a6da-4e26-b358-efba3bf15c33/Fluoroscopic Shoulder Hydrodilatation for Frozen Shoulder.mp4?sv=2019-02-02&sr=c&sig=8KVOKT8Ns92ljSFtM2WIyV%2BuO2pxHcyuVFcCeWJmEMM%3D&st=2024-11-21T13%3A56%3A10Z&se=2024-11-21T16%3A01%3A10Z&sp=r
Upload Date:
2024-06-01T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
DR VINAY SINGH: Hello, viewers today, I'm going to demonstrate to you how to do an injection of shoulder under fluoroscopy, and I'll also show you how to do first opaque hydrodilatation for frozen shoulder. Frozen shoulder is a self-limiting condition, which is extremely common in India. However, a lot of times patient presents with marked restriction of range of movement like in other patients, as well as pain.
DR VINAY SINGH: Hydrodilatation is a recent procedure which is pretty good in relieving pain, and I'll show you how to to do this under fluoroscopy today. So in terms of the theatre setup, the c arm is going to come from the other side, our screen is right there. The patient position will be supine. The hand and arm, and the forearm, should be on the side and the arm should be externally rotated.
DR VINAY SINGH: This is to get the biceps tendon out of the way. It's much easier to negotiate the needle. So the patient is struggling. So ideally, patient's arm should be on the side and in neutral rotation. Not internally rotated on this occasion. She is keeping it internally rotated. I'll get somebody to hold the hand in this position while I'm injecting.
DR VINAY SINGH: So this is our X-ray. Before you proceed, always make sure that your position is good enough to take a good X-ray. So what is the ideal position? In terms of ideal position, you want to be aiming for anteromedial aspect of the humeral head. So this is the superior part, this is the medial part, this is the anteromedial part.
DR VINAY SINGH: This is where we want to aim, and this should be in line with the coracoid process, so we are aiming for roughly this part of the head. If you are here, you are too lateral, if you are here, you are too medial, you will be hitting the glenoid, we just want to be here. So this is where we want to enter in line of the glenoid process. Perhaps here would be perfect.
DR VINAY SINGH: Now hydrodilatation is an extremely useful procedure which is good in relieving pain in around 90% and improving range of motion around up to 70% of the patient. Now, the equipment that we will be needing is, just, this is the artery clip just to localize our perfect entry point, then we'll need the spinal needle. This is used to do hydrodilatation.
DR VINAY SINGH: This is size 22, as well as giving local through the track so that the patient doesn't feel pain. This is some local anaesthetic, this is our only big dye. This is a {inaudible}. I give 80 milligrams with some 1% lignocaine. These are two 20 ml of saline to do the hydrodilatation. This is a connector, which is extremely useful when you do that.
DR VINAY SINGH: And I'll explain everything again, as I go through the procedure. So, first step is to localize your ideal entry point. So I've just used a mosquito and taken a c arm view and this looks [like] the position of where we should enter our needle to do our hydrodilatation. So if you look at the CL images, this is our ideal entry point, so this is the anteromedial aspect of the head, and it is in line with the coracoid process.
DR VINAY SINGH: So I mark my entry point, I'm just going to give some local anaesthetic. {inaudible} This is to anaesthetize the skin. So the next step will be just to use the spinal needle and just go slowly and infiltrate the whole track so that the patient doesn't feel pain when we're doing the procedure.
DR VINAY SINGH: So the third step will be to choose the same entry point and go vertically 'til you hit the humeral head. So I just felt a giveaway, I'm just going to confirm the position, whether I am in the shoulder joint or not. So, looking at the position of the needle, it looks pretty good to me. It is at the anteromedial aspect of the humeral head and it's also in line with the coracoid.
DR VINAY SINGH: I just need to confirm this position with injection of around a mil of omnipaque, and if it is correct then we will proceed with hydrodilatation. So I'm just going to inject a bit of omnipaque. Make sure that, once you feel that you are in the right spot, protect this needle like your life, so that it doesn't go in and out. Otherwise it's very easy to come out of the joint. So this is our picture,
DR VINAY SINGH: and this is how the arthrogram of the shoulder should look. It is nicely following the contour of the humeral head. This is some dye going on to {inaudible}.
Form Title Download
Form Title Bookmark
Form Title Share
Form Title Cite
