Dr. Hirahara treats rotator cuff tendinopathy with a cortisone injection under ultrasound guidance into the subacromial space scarred by previous surgery.
hi i'm dr alan hirohara from sacramento california the next patient that we'll be seeing is a patient that has a partially torn rotator cuff on his right shoulder we had diagnosed that with mri he had actually had previous surgery and he had had actually a previous labor repair and now he comes in with a new injury with new problem with the right shoulder unfortunately he has had a previous decompression in the chromioplasty so the subacromial space is unfortunately been obliterated and is scarred down we'll be giving him a cortisone injection to the subacromial space under ultrasound guidance however it will be a bit difficult to do since it won't be the normal anatomy where we normally give a subacromial injection it enlarges the space very easily and flows very nicely in there'll be scarring in the area and it'll be more difficult to get in and that's why ultrasound will be critically important to make sure i'm in the right spot we're now going to go ahead and do the ultrasound and have a look what's doing and we're seeing here very nicely the tuberosity you see it's irregular that indicates some chronic tendinopathy some cystic changes in the bone itself we can see also a bit of a thickened area with some hypoechoic areas on the bone and that might indicate that partial tearing right there but again definite tendinopathy different swelling so we're going to get to that subacromial space so now it looks like we're ready to go and so now we're ready to hit our spot what we're looking for is that double white line of the fat and there it is nicely there we're going to get right under that spot and that'll be our sub criminal space so that's going to be our entry point right there so we're going to get this cleaned up so we're going to clean it up first get it prepped now i'm going to use ethyl chloride to numb the area one of the key points in this is making sure that you're nice and perpendicular and square to the bone and tendon when you're doing your ultrasound to make sure that you're in the right spot and you have a good angle and there's our spot right nicely right there there's our best best angle okay here we go poke you see the needle coming in and to our area nicely right there hey junior guy all right all right let me get into that spot a little bit better there we go there we go nice that's pretty nicely there okay i can feel it yeah i can feel it too almost done and we're finished all right all done
