Psoas muscle/bursa injection

[gaschicago]

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How are yall doing psoas muscle/bursa injections? Tips on avoiding vasculature? Tips on patient who have had THA so hardware is present? What are you putting in the injectate?

 

[JBM16BYU]

Ultrasound-guided. Short axis, in-plane, lateral-to-medial approach. Avoid vasculature by identifying with doppler prior (important vasculature and femoral nerve should be medial to psoas bursa). Depending on surgical approach for THA, musculature may appear different than normally visualized. I've seen 2-3 cc's lidocaine (or 2-3 cc's ropivacaine) mixed with 1 cc depomedrol.

 

[deleted875186]

I’ve done this with X-ray, there is a paper on it, slightly oblique X-ray to come slightly lateral to medial, feel femoral pulse to make sure it’s medial to needle, go slow advancing needle to bone, and then take straight AP once on bone, inject contrast.

 

[oreosandsake]

iliopsoas tendon?

look up PENG block. essentially same. target the tendon sheath at the iliopectineal line, you have a backdrop of bone. vasculature is much more medial.

 

[Gauss]

iliopsoas tendon?

look up PENG block. essentially same. target the tendon sheath at the iliopectineal line, you have a backdrop of bone. vasculature is much more medial.

he's asking about THA so the anatomy will look vastly different but it's the same approach really - for US, lateral to medial in plane SAX to tendon, target is around the bone & metal cup interface, usually the tendon gets caught there. the tendon could be huge and very tendonotic so it's tough, easy way is to go under the tendon and touch bone, retract a bit. sterility is the risk, you will inject around the hardware and even into the arthoplasty space. I would not inject much if any anesthetic at the tendon, you can inject a bit superficially, skin wheel and a bit deeper. 2 - 3.5 inch 25 or 22g needle, avoid particulates - could do a dex/celestone even toradol mix since it's supposed to be 'tendon sheath' and particulates under US can obscure your view, low low volume (1-2 mL max) as it's uncomfortable with too much and they won't be able to hip flex which you know wasn't a femoral block if you don't inject anesthetic.