Maverick 3 Flashcards
Illioinguinal Nerve distribution and indications
branch of anterior rami of L1
across QL laterally and illiacus as it approaches the iliac crest, wraps anteriorly and pierces the transversus abdominis and internal obliques
Anterior scrotum/labia, root of penis, small portion of anteromedial thigh,
commonly after nerve entrapment following hernia repair.
Illiohypogastric is lateral and illioinguinal is medial
Illioinguinal Neuralgia presentation
Burning pain in lower abdomen to the scrotum. Occasionally in the upper thigh but never into the knee
Novice skier position = relief, spinal extension = worsens
Illioinguinal probe placement
transverse oblique orientation over ASIS pointed to umbilicus
Illioinguinal Injection
fascial plane between internal oblique and transverse abdominis
in-plane lateral to medial
Genicular Nerve Block Includes
Obturator (posterior capsule), Saphenous/Femoral (supra/infrapatellar - anterior knee) and Sciatic
Inferior Genicular Nerve arises? Supplies?
Arises from infrapatellar branch of the saphenous nerve.
MCL, Medial anterior/inferior of capsule
Superiolateral Genicular nerve origin? supplies?
Nerve to the vastus lateralis (branch of femoral)
Superiolateral and anterior aspect of knee
Superiomedial genicular nerve arises? needle depth?
arises from nerve to vastus lateralis (branch of the femoral nerve)
needle tip 2/3 depth of the femur, anterior posterior needle direction.
Facet Joints: function? components? location?
Superior and inferior articulating joints
provide structure/stability by forming form articular pillars
between pedicle and laminae
Facet innervation
innervated by the medial branches of the dorsal rami of the superior vertebral level (L3/4 is innervated by L2/3).
medial branch runs in a groove formed by junction of the inferior transverse process and superior articulating process.
runs under the medial curve mammillio accessory ligament before innervating the multifidus muscle which holds the nerve in place. then splits into two branches superior and inferior
L5 crosses sacral ala gives medial branch as it reaches the caudal aspect of the L
Paramedian Sagittal Transverse Process View “Trident sign” - fingers behind Transverse process.
Paramedia Sagitta Articular Process View - Camel humps
continuous hypoechoic base connecting vertebrae
Paramedian Sagittal Laminar view
“Sawtooth” - lamina or non continuous hyperechoic line
Paramedian saggital oblique view - caudal tilt optimizes view; dura is the hyperechoic line
Articular process and TP are visible. Transverse interlaminar view.
Target for MBB on US
between SAP and TP for transverse interlaminar
anterior surface of Lamina for parasagittal
Sacoilliac Joint Innervation
L4-S3 Dorsal Rami - Posterior or dorsal capsule
L5-S2 Anterior Rami - Anterior or ventral capsule
SI provocative tests
3 of 5 must be positive
SI Dysfx Presentation
Buttock Pain most commonly
Pain over PSIS (or within 10 cm)
aggravated by activity and sitting
ALWAYS below L5
SI Joint Target on US
Trigger Points
Hyper-irritable spot in a taught band develops from overuse or repititive micro trauma, jump sign is confirmation
Shoulder Innervation? Probe placement for Glenohumeral? needle trajectory? target?
Suprascapular - Anterior and Superio
Axillary - Posterior/Inferior
probe is caudal to the acromion over the infraspinatus tendon
needle lateral to medial inplane…target is under infraspinatus tendon but off humeral heal
Glenohumeral Injection
target is Posterior Joint recess
Subdeltoid/Subacromial Bursa landmarks? presentation
Humeral head, deltoid muscle, supraspinatus and acromion
knife like pain with abduction of shoulder, can’t sleep on shoulder
Subadeltoid/Subacromial Injection probe placement
patient sitting with arm neutral
Coronal plane over the middle deltoid and acromial process
injection between supraspinatus tendon and deltoid
Subacromial Bursa injection
Hip is innervated by?
Probe position for intra artciular?
Target?
Needle direction?
Femoral obturator and sciatic nerves
Longitudinal plane, placed parallel Proximal Femur - scan up until you get to the medial margin of the femoral neck and head which is the target site.
needle goes from inferior to superior?
Intra articular hip injection
Hip is innervated by?
Probe for Trochanteric Bursa Injection?
Target?
Needle direction?
Femoral, Obturator and Sciatic nerves
transverse over GT, patient in modified sims
Between the GT and tendon of gluteus medius and iliotibial tract
GT Bursa Presentation
Point tenderness over GT
Walking up stairs is an issue
lateral hip pain
GT Bursa injection
Needle inserted A-P
Injection between tendon and GT
Intra articular Knee Injection probe placement
Intra-Articular Knee Injection Landmark?
Needle orientation
MCL
medial margin of femur
medial margin of tibia
out of plane
Suprapatellar Bursa Injection:
probe Placement?
needle trajectory?
injection site?
presentation?
placed over superior pole of patella (must palpate)
in plane, inferior to superior
between the anterior distal femur and distal quad muscle; held in place by articularis genus muscle
can’t walk down stairs or kneel, point tenderness over superior anterior knee, resisted extension and passive flexion cause pain
Supra patellar knee injection longitudinal view, needle goes inf to superior
suprapatellar knee injection, transverse orientation
Stellate Target
Anterior Prefascial Surface of longus coli
7cc mix PF lido 1% and 10 mg of decadron
C6
C7
