Ischiofemoral Block

[BobBarker]

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Ortho asked me to do an ischiofemoral block for impingement. Anyone done one?

 

[Snowmen96]

It would be an injection of the quadratus femoris muscle in the space between the ischial tuberosity and the lesser trochanter.

Injection is pretty deep. Can be done under ultrasound in thinner and echogenic patients. Otherwise, more accurate to have it done under CT guidance.

 

[RoloTomassi]

Yeah super easy. Prone AP. CLO until ischial tuberosity and lesser troch are kissing. Touch down on lateral border of ischial tuberosity, walk off to touch down on troch, pull back half the distance and you'll be in belly of muscle. If you look at axial cut of MRI you'll see what I mean.

 

[BobBarker]

Great, much rather do this with fluoro. I have been using the very nice US at the ASC for the rare us guided ilioinguinal block.

 

[JFS]

I took the opposite approach as above as when I reviewed the anatomy on MRI sciatic and vasculature was closer to ischial tuberosity than trochanter and there was more muscle belly that overlies the lesser trochanter.

Prone, slight ipsilateral oblique to line up trajectory closer to edge of lesser tuberosity. Touch done on os, back up a few mm and inject. Slightly deep but easy injection. 100% local relief with just 1 ml of 2% lido on 2/2 patients I’ve done it on

 

[BobBarker]

What code did you guys use?

 

[BobBarker]

Went great. Orthopedist was very happy with the contrast spread.

 

[epidural man]

I’ve done them under CT a bunch of times.

I sometimes find the hamstring origen is usually the most painful issue. Do a peri-tendon injection with PRP. I used to use AmnioFix for this but that went the way of the DoDo bird. Are there any cell matrix injection products still available?

 

[MitchLevi]

Miserable glute and pelvic pain. Prob gonna do this injxn.