hi my name is Trent barrettson I'm an naturopathic doctor in practice in crime Brook BC and I'm here with Rico who has bilateral knee pain and we're going to do a Durland injection in both his knees on his left knee we're going to do the super patellar pocket from the lateral portal and on his right knee we're going to do the para patellar pocket from the medial side which is Midway up the patella so let's start by scanning Rico's knee we notice first off there is no effusion let's increase the gain a little bit okay and we are right there all right so what I'm looking for here is the super patellar pocket and in Rico's case it's very very small and not super obvious but it is there and so we are looking at about two centimeters depth and let's switch into short axis and so I'm going to toe in a little bit and I'm just going to confirm in Long axis that I'm in the right tissue plane right there too okay all right so for Rico I'm going to have to inject quite close to the proximal end of the patella to be comfortable getting into the knee if we go too far proximal up into the Super patellar pocket I'm concerned that we're going to just put the duraland into fluid okay repo here we go you're going to feel a small poke so I'm towing in a little bit that just opens up some extra space for me I'm going to come down two centimeters one two little poke here gonna feel some pressure as I inject the local tender and there's the there's our needle right there okay I'm going to add a little bit of fluid just to see if I can bulk up that space a bit how you doing Rico okay there we are right there and I'm going to reorient my needle you okay yes okay you can see it filling right there and I'm right just at the top end of that space okay I'm happy with that touch of the needle this should be numb you still good a little bit uncomfortable hey this is because I'm right close to the proximal end of see how I came a little low there and I was up against the lateral condyle of the femur and that's what caused him some discomfort so now I'm in Long axis and you can see the tip of the needle is right there I'm injecting right now and it's important to always inject in Long axis when you're injecting with the super patellar pocket because in this position you can see fluid accumulating if it's not flowing into the joint and I'm pressing are you okay yeah and all there's no fluid accumulation there there's the tip of the needle there's absolutely none which means all of it is just advancing into the knee joint okay and as you get close to the bottom make sure you bottom the syringe out there we go and we're there's the fluid pocket that accumulated so now we can see the distended super patellar pocket now that we've put some fluid into it so I was absolutely in the right cavity we injected three milliliters of duralane which is a cross-linked hyaluronic acid that acts as a shock absorbing anti-inflammatory very slippery substance that is naturally found in knees and as knees age or become diseased the amount of hyaluronic acid decreases so this is a an injection to replace that hyaluronic acid and patients can expect anywhere from a very poor result with no benefit to up to six eight months of relief with a single duraland injection foreign
