00:00:01;04
–
00:00:47;22
Where? Where am I going? Okay. Like right under the cervical. You get headaches up here or. No. Yes. Yes. Okay. So I'm going to do right under the occipital here. Yeah. Right on the occiput. Okay. Can you can you lean forward with your neck? Okay. So she she has pain where she's pointing to basically the occipital notch or below it, really around the level of C one c2 right under the occiput.
And I'm going to look with the ultrasound and give her an injection there. When the insurance is not involved in the patient is paying for the PRP herself. I have the freedom to do whatever I need to do that day. Unfortunately, when the insurance is paying for the injections, typically they will never approve more than one injection per per day.
So hopefully this will give her a relief. And
00:00:48;22
–
00:01:17;25
let me just look at what's going on here. So sometimes when I do unfreeze the upper cervical spine, I go to the actual location of the articular pillar of the facet at the level of C2, and sometimes I go to the occipital nerve. In her case, it's more of a pain at the level of C2 than an occipital headache. Correct.
It's not going up to your head right now. It's more right here. So because of that I'm going to look at the articular pillar at C2.
00:01:18;28
–
00:01:31;05
And the way C2 is identified is usually it's the first bifid spinous process after leaving the spine. So C2 is the first bifid spinous process upon leaving the spine.
00:01:32;28
–
00:01:33;11
True.
00:01:34;18
–
00:01:48;12
Okay. Here we have a I fit spinous process in the upper neck. And I'm going to go lateral passing by the lamina of C2 and the occipital nerve which is right there. And then I'm going to go even more lateral to the
00:01:49;12
–
00:01:51;14
articular pillar of C2.
00:01:58;04
–
00:02:09;25
Right here. And you can get the medial branch which contributes to the occipital nerve, as well as alleviate the axial symptoms that she's complaining of. So I'm going to give you a little pinch right here okay. Pinch.
00:02:16;17
–
00:02:34;08
Resting right on the articular pillar. A little pressure here. How are we doing? Okay. Is this the area of your pain? It's bilateral. Yeah. I'm going to do the other side. But is this where. Yeah. Okay. Capture image. It's higher up your pain. Like a little higher. Right under the bone. Right under the bone. Okay.
Right here. This level.
00:02:40;14
–
00:02:45;20
Let me do the other side first, and then I could. And then I could go up higher. Okay. So unfreeze.
00:02:46;27
–
00:02:47;25
Okay. So.
00:02:50;09
–
00:02:57;23
So the patient requested to have a little extra medication put by the occipital nerve. So right now I'm going to
00:02:58;24
–
00:03:11;14
find it by fit spinous process. Come lateral. Look at the oblique inferior muscle that is lying on top of the C2 lamina and angle my probe parallel to the muscle fibers.
00:03:15;25
–
00:03:17;00
Decreased depth.
00:03:22;07
–
00:03:34;22
And the nerve usually is one structure, but occasionally you can look at multiple. It's in that plane between the semi spineless and the or the speediest capitalist in obliquus capitis inferior muscle will pinch.
00:03:36;28
–
00:03:46;15
Right over here that go up to your head. No, that's a spot. Okay, good. That's a good sign.
00:03:49;06
–
00:03:58;27
There we go. Okay, well we're done. I hope you feel better. Okay. Thank you. Thanks for being so patient with us. That's amazing. Oh, good. Okay.