hi my name's Trent Britton I'm an naturopathic doctor in Cranbrook and I'm here with Rico who has bilateral knee pain we suspect osteoarthritis and he's responded well in the past to Duran so today he's getting bilateral Duran injections we just did the super patellar pocket access from the lateral side on the left knee I'm now going to do the medial parapatellar access on the opposite side from me medial to lateral for Rico so I'm going to just locate here oh sorry Rico okay right there okay so what I'm doing now is I'm marking mid patella and I'm just going to place a small divot pressure in the skin and then I'll go ahead and clean the reason I'm doing that is because this injection is ultrasound informed this is not an ultrasound guided injection we're simply identifying femur on the bottom end patella on the top end you cannot see your the the bottom into the joint all you can see is sort of the sandwiching of the femur on the bottom and the patella on the top this injection is done with the knee fully extended and we'll start with some local anesthetic and so what I've done is I pressed the patella towards me and I palpated the deepest Groove between the Pella and the femur it's simply that spot that your finger naturally rests into as can you relax your leg for me yeah there we go as you gently press the patella toward you and de press press your finger in that deepest point where your finger settles is where you want to enter with the needle and so I'm going to Simply add a little bit of injection here with 1% lidocaine simply to numb the injection root and I'm now in the knee joint with the local anesthetic okay so as I said this is an ultrasound informed injection this is not an ultrasound guided injection so on the left of the screen we see the hyper aoic line of the medial edge of the patella on the right side of the screen we see the medial cile of the femur and smack in the middle of that is right where I'm just off center from my DOT is is right where my DOT was and that Valley is the knee joint and so I'm going to come in out of plane all right so here's a needle touch this should be pretty numb and so as you can see this I'm doing this out of plane and I'm doing this as an informed injection okay relax just relax sorry Rico relax that leg relax that leg try hard I know it's hard just let this leg go you're there you go there you go so when the quadriceps contracts it pulls everything in and if you hit bone you have to just slightly adjust so there I was just I was a hair too deep and so I just touched onto the edge of the femur and now I'm right in the joint I just slightly adjusted the needle and this is absolutely normal in this injection because it is ultrasound informed so now I'm in the joint and the fluid is flowing in without any resistance are you okay Rico can you relax your leg again totally let it go just let the table hold you you're doing great and we're almost there okay good all right there we go
