so look at the supraspinatus we can see it here I want to come posterior enough to be able to see it nicely and they can see it really well there you can see it actually looks like this guy even has like possibly a partial tear of his cuff you can see it's not looking great there so there's different things we can do so if you're going to do like an injection for subacromial space this would be the ideal spot doing it right here and then coming into the area you can see going right under that kind of double white line right there we can kind of optimize our image there so there we're in the subcriminal space right now boom so we would inject that spot so if you want to inject you can see it kind of going in there's a little bit of fluid going in that area but you can see it's migrating all the way right from kind of meal to lateral so we know we're in the subcriminal space if we're doing like a PRP injection and we were more concerned about making sure that we had actual injection into the tendon we can reorient actually go into what you can't do with Cortisone and that's not going to be appropriate for cortisone but going into the actual tendon itself let me get a better image here and there you can see it since I've changed the angle I'll change my angle here and kind of come in a little bit more angle there so you can see it I'm right in the shot and I'm right there into that partial tear and I can see the needle going to that partial tear seeing it right in that area there so you can get more into that spot in the incharticular portion so I'm actually into the actual tendon tear now let me get you a better image there's our needle there you can see I'm right into that area of the tear there so if you're doing an injection and I'll do a little puff of fluid in that I want to do too much but you can see I'm actually in the joint you can see it flowing into the joint there this is not an ideal area to do incharticular injections but it is possible to do it's just a little more chance you're going to hit the cartilage and I would guess right now that my needle is probably in the articular cartilage inchartically currently right now because I can see the needle head in that direction and that's why typically we're doing a PRP we want to get actual to the insertion site right there so that would be the better spot for a shot right there so subacromial there in charticular or into into a relative cuff supersize tendon right there and that's how we do those shots
