hi I'm James Escalon physical therapist with wellward medical here in Lexington Kentucky and a faculty for the American Academy of manipulative therapies Fellowship in muscular skeletal ultrasonography today we're going to be looking about needling dry needling in fact of the supinatus tendon how you're going to be getting this patient into the position safely is to be in a sideline position as shown here with the ipsilateral hand on the ipsilateral buck this is known as the modified grass position try to have a pillow or something underneath this arm to make sure that they're comfortable and totally relax which is going to make it more painless for this patient when we're inserting the needle what's going to be happening is you need to trace the tendon from the supinatus FASA from medial to lateral until you're at the greater tuberosity when you're at this point you'll be able to clearly see the insertion of the tendon onto the greater tuberosity on the clarus which I'm demonstrating use for today now when we're looking at this you can use the talk mode which will help us guide it with a hands-free position so that I can make sure that if I have to make little adjustments as I'm going along this is safe for the patient and more comfortable and sterile when we're looking at the image for when the needle is coming in make sure the needle is coming from a lateral to medial and also a posterior to anterior position for appropriate insertion upon the most sensitive area which is more than likely going to be the deeper component of the enthesis on the superspinatus the articular side once you have found a good end feel for this you'll be able to have not only visualization of the tendon using the needle mode on this ultrasound but also also there should be a familiar pain elicited by the patient okay that's how you do dry needling of the supinatus tendon
