Name:
Fluoroscopic Intra-Articular Hip Injection
Description:
Fluoroscopic Intra-Articular Hip Injection
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/fbd7e5d2-8356-4eba-9371-10adb109c6f8/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H05M00S
Embed URL:
https://stream.cadmore.media/player/fbd7e5d2-8356-4eba-9371-10adb109c6f8
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/fbd7e5d2-8356-4eba-9371-10adb109c6f8/Fluoroscopic Intra-articular Hip Injection.mp4?sv=2019-02-02&sr=c&sig=MXlPa8Sp77Am9WkAEbJ0gmM3OR5KrX36kVYN%2F3TDX5M%3D&st=2024-11-21T16%3A53%3A29Z&se=2024-11-21T18%3A58%3A29Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
DR VINAY SINGH: Today, I'm going to demonstrate to you how to perform a diagnostic hip injection, today we are going to do an intra-articular injection for a gentleman who has got back problems as well. And clinically, we think it's the hip that is giving him pain. However, in your clinical practice, you will find a lot of times it's very hard to determine whether the pain is coming from the back or from the hip.
DR VINAY SINGH: I would recommend that, in those cases, either give another block in the back or give intra-articular injection to the hip to delineate whether it's the hip or it's the spine that is giving the problem. So there are many ways to do an intra-articular injection. I will show you a technique in which we are going to use lateral approach.
DR VINAY SINGH: You can use anterior approach. You can do it with ultrasound or you can do it with fluoroscopy. Today we are going to do a lateral approach with fluoroscopy on this gentleman and we will do an intra-articular injection. So this will be the setting for the injection. The c arm will come from the opposite side of the area that we are going to inject. The leg has to be in slight internal rotation to see the full profile of the leg. That makes your life much easier.
DR VINAY SINGH: So there are many described ways of doing the hip injection. You can go from the front or you can go from the side. I would like you to learn a few techniques. So I have marked, this is the ASIS: anterosuperior iliac spine. This is the greater trochanter and I have used C arm to mark it. So the first line that I have drawn is from ASIS, which goes through the centre of the patella, and the second line starts from the tip of the GT and meets with the first line.
DR VINAY SINGH: So this is our meeting point here. Now from ISIS to GT, I have divided this roughly into one-third and two-thirds. So there are many authors who have described different techniques. If you want to do this under outpatient as an OPD procedure without image guidance, then you can directly go here in the front. And once you hit the neck because the whole idea is to hit the femoral neck and to be inside the capsule.
DR VINAY SINGH: So once you hit the neck, you can inject after withdrawing. The second technique is that this is our target, this is [where] we are aiming. So if you are using a spinal needle, so you start from this one-third and two-thirds junction and aim towards this target point and you should hit the neck and you can inject this as well. However, I like to go just from the top of the GT and I will show you how I do it.
DR VINAY SINGH: So today we are going to use a lateral technique, lateral approach, to inject. So this is our local injection that I will use to anaesthetize our track. This is the omnipaque that will be used to confirm the location of the needle, whether it's in the joint. This is a spinal needle, around 21-, 22-gauge will be fine. And this is the steroid mixed with some local anaesthetic that will go into the joint.
DR VINAY SINGH: So first thing is to inject local and I have checked it, we'll just go for roughly a centimetre above the GT, and we'll inject the whole drug so that the patient doesn't feel pain when we are injecting. So I use the spinal needle to inject the whole track because sometimes he may require multiple penetrations, so you don't want to give pain to your patient. So this is our whole track infiltrated.
DR VINAY SINGH: So I'm going to use the same needle now, following the same track, and I will check in the fluoroscopy whether I'm at the right place. So now you can see that our needle is on top of the GT and I'm just going to angle it slightly on the top so that it hits this area. We are aiming for the lateral aspect of the neck. You don't necessarily have to go into the hip joint. So I'm aiming for the lateral aspect so that it is just underneath the capsule.
DR VINAY SINGH: So now this is our position and, it looks ok, but I still have to check with omnipaque whether I am inside the joint or not. So, initially I tried and it was not going, so I had to readjust my position. So now you can see that {inaudible}.
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