Hip RF question

[drrosenrosen]

I've run into this problem a number of times when doing blocks or RF for hips: the femoral articular branch (12 o'clock position) tends to be overlayed by the psoas tendon. I got this contrast pattern today:

I moved the needle from one side of that streak to the other before I finally got some non-psoas contrast at this more medial position. Any suggestions for avoiding this? Coming in from more laterally to get under it?

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[buddababa]

I've run into this problem a number of times when doing blocks or RF for hips: the femoral articular branch (12 o'clock position) tends to be overlayed by the psoas tendon. I got this contrast pattern today:

View attachment 340158

I moved the needle from one side of that streak to the other before I finally got some non-psoas contrast at this more medial position. Any suggestions for avoiding this? Coming in from more laterally to get under it?

I usually come in more lateral to get to that position

 

[lobelsteve]

I start inferolateral from your start. If contrast not flowing, rotate needle tip 180 and advance a mm.

 

[Orin]

I've run into this problem a number of times when doing blocks or RF for hips: the femoral articular branch (12 o'clock position) tends to be overlayed by the psoas tendon. I got this contrast pattern today: I moved the needle from one side of that streak to the other before I finally got some non-psoas contrast at this more medial position. Any suggestions for avoiding this? Coming in from more laterally to get under it?

It's a fluoro guided PENG block.

PENG Regional Block - StatPearls - NCBI Bookshelf

www.ncbi.nlm.nih.gov

Agreed though, more laterally and slide under. The bevel of your needle may be too long when the tip is touching bone to get under the tendon.