hi Dr Frank Johnson from Sports Medicine ultrasound I'm here to demonstrate a cortisone injection into a knee my patient is an avid soccer player been playing his whole life wants to continue playing unfortunately he's had some significant injuries to the left knee requiring an ACL reconstruction and there's been two significant injuries to this right knee also requiring surgery we're having symptoms on the the medial joint line but to get cortisone into the knee joint what we do is we simply go into the Supra patellar recess again the old way would be to go through the front and hope you're in the knee joint another way would be to go under the patella but the trouble is you're definitely going to hit the femur or the patella if you do that but if we use ultrasound we can identify the fluid within the Supra patellar recess and pop the needle in almost painlessly it's not going to be completely painless but it's going to be an amazing injection you're going to love it it's gonna work great too all right so what do we see right hand side of the screen patella here's the quadriceps tendon here's the super patellar fat pad bottom of the screen we see the femur and the pre-femoral fat pad between the two is a little bit of synovial fluid it's a little hard to see so I'm going to sweep to the lateral third of the patella and see if I can see a bit more fluid well I can definitely see the pre-femoral fat pad better but I can't see the fluid perfectly and I know the femoral condyle is there so what I'm going to do is I'm simply going to flex the knee into about 60 degrees of flexion go ahead we'll get up to about there perfect and what that does is that allows a little bit of fluid to pop out and actually that's a little bit too much so let's go down I'll straighten it a bit perfect that's about as good as I can get I'm going to add a little bit more skin disinfectant as my ultrasound signal transducer I'm now going to rotate the probe 90 degrees and just here on the screen I can see the articular cartilage of the femur and just above it a little bit of joint fluid without ultrasound this would be almost impossible so I stabilize everything little poke I pass the needle in now you can see my needle just there touching the lateral femoral condyle all I have to do is make it rise Just a Touch Above and just there I'm actually into a fluid compartment and if I inject the fluid you can see it flowing all the way over to the right hand side of the screen that's it that's our intra-articular knee joint injection into the Super patellar recess
