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What you see here though is the size is large bone to the side.
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Typically at the level of the size you can see the S1 foramen which.
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Is right about here as the bone disappears in the center.
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Now I'm going to reverse the orientation of my ultrasound so that the right side of the patient
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is on the right side of the screen, and I'm going to come laterally. You see the
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spine of the L5 vertebral body and then the lamina to the right. And at this location I'm
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going to angle it upwards to see the facet joint, because if I come directly transverse across the
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CIS will be in my way as such. See, this is the CIS coming into view. So if I'm coming to the l5 s1
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facet joint, I'm going to angle upwards to get over the iliac crest. Choo-Choo. It will.
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I am coming into the bone right here, and I just landed on the.
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It's basically on the facet joint. I'm going to aspirate and inject about one milliliter in
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the region. Now, this is not the same as a fluoroscopy guided or joint injection in
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which we use contrast, but just getting the medication around the joint between the and the
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lamina and at the capsule will give him some relief.
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This patient also had a positive on the cis localized right, where the superior medial branch
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of the nerve passes. These clinical nerves are from the dorsal ramus of L1 through L3 and in
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some cases L4 and L5, and they pass through the thoracic lumbar fascia. They can cause lower back
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pain. So when you do a facet injection or an epidural and the pain is still not relieved, you
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should consider this. Many patients will have tender spots over the colonial nerves, which would
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be a sign that there may be some irritation. And many of these patients will not only get
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localized pain relief when you inject the nerve, but they will get relief of ridiculous symptoms.
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Even though this nerve does not go down the leg, it refers down the leg, but it's localized to the
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gluteal region. So as I'm scanning him here, you could see by the CIS there's a Hyperloop and
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there's multiple branches of the colonial nerves. I'm going to just aim at this hyper lucid
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structure, which I am going to assume is the colonial nerve because of its location and
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because of patient, localized pain there. Choo choo bullet. Mhm.
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Okay. So.
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So now the needle is right above the nerve and I'm injecting and I'm going to another spot which
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may be involved in this pain on top of the size. We're done. Basically
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the cortisone injection may take a few days to work. The local will work within a few minutes, and
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I anticipate this patient will do quite well after the procedure.