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Janet's a patient who had a platelet rich plasma injection six weeks ago into her lumbar spine. Her lower back is 60% better. Today, she still has some pain down her leg and in the groin, as well as in the knee. Her imaging came back with arthritis of the knee as well as the hip. And today I'm going to do an injection of PRP into the knee joint and more into the hip, because that appears to be her main problem.
And under X-ray later we might do something in the sacroiliac joint or by the exiting nerve roots. But for now, under the ultrasound, we're going to examine her knee. I'm in the super patellar position, and you can see here as I scan distally.
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We could see the super patellar tendon.
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And below it is the fat pad. Can you straighten your leg a little bit more? Okay. Thank you. I'm also going to reverse my orientation so it's consistent with the patient. So here we see the rectus femoral muscle with the tendon inserting into the super patella.
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tendon right here.
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And
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as I rocked the probe, you could get on to the patella and see the bone.
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Right here
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you have
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the.
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Bone and fat imaged on the T mode.
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As well as the space between the fat pads, the pre patellar fat pad, and the super patellar fat pad that leads into the joint. And that's the the black space between the fat pads.
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In a transverse section I could see a cross section of the super patellar tendon on top. And it looks irregular because she has arthritis
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this is not a normal scan. So the anatomy is a little bit off. Can you straighten your leg just a little bit please B mode.
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There's some fluid above the fat pad, and that would be our target location. I'm just trying to optimize it right here.
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Can you bend your knee a little more?
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Thank you.
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Here's the trochlear. It's a little divot right here.
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And there you can see a little effusion between the super patellar fat pad and the pre femoral fat pad. I have an alcohol swab, please.
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I'm going to inject only a small amount of PRP here because her larger problem is in the hip.
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And that's where I'm going to focus the majority of the inject date. Now I'm going to come from a lateral approach. As you notice the PRP is red. It's blood tinged. There was some blood that got into the PRP small amount which can cause some more inflammation. But when you do get blood in the sample, you do get pretty much all the platelets.
You're not missing out.
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So there's going to be a little pinch okay. Pinch.
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And pop right in right there.
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Okay.
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So now we're going to move on to the hip. Are you good. When localizing the hip I find the greater trochanter Bursa. And I try to line up my, my probe parallel to the neck of the femur and aim towards the capsule of the joint. Here you can see it's quite irregular because she has a significant amount of degeneration.
So I'm going to go in with a 3.5in 25 gauge and you'll decrease depth.
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Little pinch
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I know. Sorry.