my name is Dr rosum I'm an Interventional pain physician to I'm going to perform PRP injections on my patient who's suffering from chronic sacc joint pain as well as a Glu btis and inflammation of the tendons inserting into the gral caner this patient has ganeric btis as well and uh a labal tear in addition um if we have enough PRP we'll do as much as we can but we're going to start off with the sacredly joints bilateral increase depth I usually start by finding the PSIs which is right here posterior superior iliac spine which is the hyperlucency most obvious in the center of the screen that's a bone Shadow it's hyperic bone with a shadow behind it as I scan medially you'll see the sacrum and the joint is fairly long it runs longitudinally and I just need to get my needle past that bone Shadow and into the joint I'm just looking for the ideal location right now just scanning and it's the same trajectory as we have with our usual fluoroscopic guided approach okay this is the spot right this is where it hurts okay A little pinch my dear okay there's the numbing sorry little pressure okay capture image the ne's coming in from the left side going down to the joint and passing the bone and just angle bit little better to get deeper into the bone I know sorry there we go and I'm popping into the joint I feel it okay dear does it feel like I'm in the area of your pain this is where your pain comes from so I'm going to aspirate which is not really necessary with PRP because you might get blood and it looks just like your PRP so it's probably not going to help you very much but it's a habit I have and I'm going to inject I'm injecting the region and it's normal trigger paint I'm actually going to move the needle a little bit different areas to get that's it and I just popped into the joint a little better and I'm injecting right now into her joint and that went very smooth the needle's coming out what one can do is one can actually give more anesthesia Outside The Joint which I could do for her because I see She's suffering quite a bit here we see a sacal framing the bone is disappearing as I scan up and down you see that right there so I could just anesthetize lateral to that region to give her some more anesthesia pinch and get down towards the bone right there you can see it spread capture image okay now we're going to find the posterior Superior on Contra lateral side okay I found it right here this PSIs and the joint is behind the hyperlucency I'm going to nesti her again now I'm using a different needle with an extension to get into the joint space you see the needles coming in just lowering my angle a bit KN is popping into the SI joint right now aspirate and inject moving the needle to different part of the joint here we go here we can see the needle coming down and we just popped into the joint and it's going in nice and smooth I know it's going to hurt it's normal okay now lastly we're going to give the PRP by her gr tranter Bersa where the tendons insert and hopefully this will alleviate her symptoms gr tranic Vera is right here so's hurting her as I put pressure on it sorry bar and moving posterior you can see the tendons as well inserting onto the Bersa right there okay so I'm going to come from a posterior approach to land on the Bersa little pinch bar KN there we go you see the needle coming in might feel pain in a second capture image capture image capture video okay we're landed on the Bersa and we're going to give some of the PRP into the Bersa as well as the tons above it almost done it's going in right around the Bersa as well as the surrounding tendons done this was a a PRP injection unfortunately it was painful for the patient because you can't mix the local anesthetic with the platel rich plasma I anesthetized the skin however you don't want the local to mix with it deeper down she's had relief from PRP in the past and hopefully this will give her the same results in the future
