air arthrogram is commonly used. But I would also say it depends on the joint. Knee: AP/lat can show the needle under the patella.
I'm talking Latin American stem cell clinics using Wharton's Jelly. I don't know if it's related to the shortage but I think it's standard procedure for most/all of them not to use contrast.
Sketchy clinic, sketchy practice. Goes together like peanut butter and (Wharton’s) jelly.
What is the kidney risk?
Lots of ways to push the capsule into periosteum and not be in the joint. That's why hips/shoulders both need contrast. I'd sat 25% of the time I am not in once I hit os. I have to rotate the needle and skive in.
Interesting, for sure I’ve seen it with hips often, personally not often with shoulders. I’m curious how do you do you shoulders?
I'm perfectly placed in the shoulder without intra articular contrast quite frequently. I retract 3-4 mm and spin the needle. One or two adjustments and I'm good. Hip is the same.
I’m sure you guys are solid with your ultrasound.
Financially speaking it unfortunately likely won’t be worth it to do a hip injection with fluoro in the ASC.
I do shoulder and knee with US. Not familiar with hip under US or how accurate it is. I have some southern size patients so I imagine it's tough.
Prone. Posterior capsule. Superior medial on the head.
Maybe he needs a refresher on hip injections under US
You greatly overestimate the abilities of docs to know what they are looking at under US. I can name two docs who I trust to inject my hip under US. One in Cali, the other in Seattle.
go anterior with flouro. SOOOOOOOOOOOO much easier
Agree completely
youre right about that... but there are more out there. and really, it's not that tough.
You know I love chopped liver but after we spent all that time together I would feel dirty having you inject my hip.
i must have been inspired somewhere.
I use the back of my left hand (which is holding the probe) to heave the pannus out of the way…
can you post your experience and techniques for SIJ ultrasound? i hate it with fluoro and only get true arthrograms maybe 25% of the time.
1. Patient prone, drape slightly more inferior than for fluoro.
Agree. Best way to be certain
We do all our scheduled MR arthrograms, and hip/SIJ in a dedicated procedure room. We do have to schedule time in that space.
There is an easy solution to that. Quit using contrast and looking for an arthrogram. If you place the needle in the joint, the lateral will tell you if you are in far enough.
Position in the joint matters. You can be in the SIJ and watch your contrast push directly extra articular.
OK maybe.
Agreed. Biggest risk of contrast is trying to continually get a good arthrogram, keep repositioning needle, more fluoro time, etc.
what about US stops this from happening? is it only the fact that you stop when you think you have just penetrated the joint on US?
I would argue US might be superior in this regard as you can easily see if your injectate is flowing outside of the joint and adjust accordingly.
Umm, we see this with live fluoroscopy.
But only for the. 5cc of contrast and maybe a washout pic. For the record, I don't think it matters.
If you are not injecting under live and then adding washout, you are not doing it right. And I also do not think it matters much.
Huh?
You do live fluoro for the entire injection? I don't claim to be the best but I've worked with numerous other docs and never seen anyone do that before unless I am misunderstanding something.
