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And above it is the tensor fascia Lata. And then on the opposite side of the
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gluteus minimus tendon is the lateral and posterior lateral facet of the greater trochanter, where the gluteus medius tendon is, and above that you have the gluteus Maximus tendon more posteriorly.
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Right here. Yeah. Okay. So
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you have the Bursa right above the gluteus medius tendon, and that tends to get inflamed quite a bit. And her tendon does look irregular under the ultrasound. And this is consistent with her MRI. She does have a tendon osis here. So we're going to first target this area and give half of the inject at the gluteus
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medius tendon and the sub and the and the greater trochanter Bursa which is above little pinch.
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Now you can also go into the tendon. Some people finish straight it a little bit to get the PRP into the tendon. I'm sorry, that could hurt a little bit.
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Doing it right.
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And after I inject, you could sometimes see the needle a little more clearly because the fluids are already there.
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Now we're going to go anterior
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to the anterior aspect of the facet
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to get to the gluteus minimus tendon, which is right here.
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Little pinch.
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So I'm right above the tendon.
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Needle mode.
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There we go.
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Is this a spot that sometimes hurts you?
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There we go. There's a nice shot of it.
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And we're just injecting the PRP around the tendon. It's a 25 gauge needle, which tends to hurt less than the larger needles. But unfortunately, the smaller the needle, the tougher it is to see under ultrasound. That's why I use the needle enhance feature of the
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machine, and that usually helps out. How are you feeling? Okay. Did I get it? Okay.
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You got more spots? Yeah. Okay. Well, I could put I have more plasma, so I could put that elsewhere. Just tell me where to put the plasma, and I'll mix some plasma with lidocaine, and hopefully it will help you. This patient's gluteus medius and minimus tendons were just injected. She feels better at that spot.
However, she has co-existing pain, possibly related to the tendon apathy. Maybe she's walking in a different way that's giving her some sort of compensatory pain syndrome. And she also had a history of back surgery. So there's all sorts of factors here that could contribute to pain of the hip and lower extremity.
Her hip joint seems fine on exam, but she has pain in the mid thigh laterally, which upon examination appears to be ilio tibial band related. And as I scan over it, you can see she's uncomfortable. So I'm isolating the ilio tibial band under the ultrasound, and I'm going to inject it right now with the remaining plasma and lidocaine, and hopefully this will give her a relief.
This is moderate to low quality PRP. This is not really rich plasma. However, plasma has been shown to be beneficial as well as liking injections when it comes to treating pain. So hopefully this will give her some extra relief. Pinch.
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Is this the spot?
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I'm injecting on both sides of the band?
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Are you feeling like I'm getting it? Completely?
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Yeah. Okay.