How To: Wrist Injection
How To: Wrist Injection
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Dr. Scott Pollock demonstrates how to perform an ultrasound guided wrist injection.
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<p begin="00:00:09.075" end="00:00:12.587" style="s2">- This is a demonstration<br />only for injecting</p>
<p begin="00:00:12.587" end="00:00:16.948" style="s2">the Median Nerve, placing<br />steroids into the carpal tunnel.</p>
<p begin="00:00:16.948" end="00:00:20.210" style="s2">So, I'm not using sterile technique,</p>
<p begin="00:00:20.210" end="00:00:22.878" style="s2">sterile gel or cleansing the area.</p>
<p begin="00:00:22.878" end="00:00:25.140" style="s2">This is for demonstration purposes only.</p>
<p begin="00:00:25.140" end="00:00:29.579" style="s2">And I am going to be doing an<br />injection in this direction.</p>
<p begin="00:00:29.579" end="00:00:32.101" style="s2">Again, I am going to be placing the needle</p>
<p begin="00:00:32.101" end="00:00:34.562" style="s2">parallel to the transducer.</p>
<p begin="00:00:34.562" end="00:00:36.562" style="s2">Apply some gel here.</p>
<p begin="00:00:36.562" end="00:00:39.019" style="s2">By placing the transducer transversely,</p>
<p begin="00:00:39.019" end="00:00:43.028" style="s2">I have in the middle of the<br />screen, the Median Nerve.</p>
<p begin="00:00:43.028" end="00:00:43.861" style="s2">I can find</p>
<p begin="00:00:45.529" end="00:00:48.480" style="s2">the Ulnar Artery on this side.</p>
<p begin="00:00:48.480" end="00:00:50.897" style="s2">And you can see it pulsating.</p>
<p begin="00:00:53.222" end="00:00:57.882" style="s2">I mark the Ulnar Artery<br />with an indelible pen.</p>
<p begin="00:00:57.882" end="00:01:02.412" style="s2">And then move just a little<br />bit to the radial side,</p>
<p begin="00:01:02.412" end="00:01:04.778" style="s2">so that the Ulnar Artery is down here.</p>
<p begin="00:01:04.778" end="00:01:07.028" style="s2">And place a 25 gauge needle</p>
<p begin="00:01:08.290" end="00:01:11.088" style="s2">in this direction, very superficially,</p>
<p begin="00:01:11.088" end="00:01:14.874" style="s2">because it's only two millimeters deep.</p>
<p begin="00:01:14.874" end="00:01:19.099" style="s2">And bring that needle in from<br />the left side of the screen.</p>
<p begin="00:01:19.099" end="00:01:23.589" style="s2">In this image, the Median<br />Nerve is sitting right here.</p>
<p begin="00:01:23.589" end="00:01:27.172" style="s2">The Retinaculum is<br />along this surface here.</p>
<p begin="00:01:28.237" end="00:01:29.545" style="s2">And the needle is coming in</p>
<p begin="00:01:29.545" end="00:01:31.749" style="s2">from the left side of the screen.</p>
<p begin="00:01:31.749" end="00:01:34.117" style="s2">This is bone down here.</p>
<p begin="00:01:34.117" end="00:01:37.867" style="s2">You'll see the needle<br />advanced superficial to</p>
<p begin="00:01:39.095" end="00:01:41.348" style="s2">the nerve and fluid,</p>
<p begin="00:01:41.348" end="00:01:45.265" style="s2">which includes steroids<br />and Lidocaine injected.</p>
<p begin="00:01:47.849" end="00:01:50.586" style="s2">In the next brief video,</p>
<p begin="00:01:50.586" end="00:01:54.223" style="s2">the needle is seen deep<br />to the Median Nerve,</p>
<p begin="00:01:54.223" end="00:01:55.940" style="s2">so the nerve is here.</p>
<p begin="00:01:55.940" end="00:01:59.976" style="s2">And the needle can be seen underneath it</p>
<p begin="00:01:59.976" end="00:02:00.809" style="s2">and again,</p>
<p begin="00:02:02.130" end="00:02:06.297" style="s2">injection with Lidocaine<br />and steroid is performed.</p>
<p begin="00:02:08.629" end="00:02:11.443" style="s2">The other approach that some people use</p>
<p begin="00:02:11.443" end="00:02:14.836" style="s2">is with the transducer longitudinal.</p>
<p begin="00:02:14.836" end="00:02:18.183" style="s2">Here's the Median Nerve on the screen.</p>
<p begin="00:02:18.183" end="00:02:22.586" style="s2">And you can approach the<br />Median Nerve this way,</p>
<p begin="00:02:22.586" end="00:02:24.419" style="s2">so distal to proximal.</p>
<p begin="00:00:12.587" end="00:00:16.948" style="s2">the Median Nerve, placing<br />steroids into the carpal tunnel.</p>
<p begin="00:00:16.948" end="00:00:20.210" style="s2">So, I'm not using sterile technique,</p>
<p begin="00:00:20.210" end="00:00:22.878" style="s2">sterile gel or cleansing the area.</p>
<p begin="00:00:22.878" end="00:00:25.140" style="s2">This is for demonstration purposes only.</p>
<p begin="00:00:25.140" end="00:00:29.579" style="s2">And I am going to be doing an<br />injection in this direction.</p>
<p begin="00:00:29.579" end="00:00:32.101" style="s2">Again, I am going to be placing the needle</p>
<p begin="00:00:32.101" end="00:00:34.562" style="s2">parallel to the transducer.</p>
<p begin="00:00:34.562" end="00:00:36.562" style="s2">Apply some gel here.</p>
<p begin="00:00:36.562" end="00:00:39.019" style="s2">By placing the transducer transversely,</p>
<p begin="00:00:39.019" end="00:00:43.028" style="s2">I have in the middle of the<br />screen, the Median Nerve.</p>
<p begin="00:00:43.028" end="00:00:43.861" style="s2">I can find</p>
<p begin="00:00:45.529" end="00:00:48.480" style="s2">the Ulnar Artery on this side.</p>
<p begin="00:00:48.480" end="00:00:50.897" style="s2">And you can see it pulsating.</p>
<p begin="00:00:53.222" end="00:00:57.882" style="s2">I mark the Ulnar Artery<br />with an indelible pen.</p>
<p begin="00:00:57.882" end="00:01:02.412" style="s2">And then move just a little<br />bit to the radial side,</p>
<p begin="00:01:02.412" end="00:01:04.778" style="s2">so that the Ulnar Artery is down here.</p>
<p begin="00:01:04.778" end="00:01:07.028" style="s2">And place a 25 gauge needle</p>
<p begin="00:01:08.290" end="00:01:11.088" style="s2">in this direction, very superficially,</p>
<p begin="00:01:11.088" end="00:01:14.874" style="s2">because it's only two millimeters deep.</p>
<p begin="00:01:14.874" end="00:01:19.099" style="s2">And bring that needle in from<br />the left side of the screen.</p>
<p begin="00:01:19.099" end="00:01:23.589" style="s2">In this image, the Median<br />Nerve is sitting right here.</p>
<p begin="00:01:23.589" end="00:01:27.172" style="s2">The Retinaculum is<br />along this surface here.</p>
<p begin="00:01:28.237" end="00:01:29.545" style="s2">And the needle is coming in</p>
<p begin="00:01:29.545" end="00:01:31.749" style="s2">from the left side of the screen.</p>
<p begin="00:01:31.749" end="00:01:34.117" style="s2">This is bone down here.</p>
<p begin="00:01:34.117" end="00:01:37.867" style="s2">You'll see the needle<br />advanced superficial to</p>
<p begin="00:01:39.095" end="00:01:41.348" style="s2">the nerve and fluid,</p>
<p begin="00:01:41.348" end="00:01:45.265" style="s2">which includes steroids<br />and Lidocaine injected.</p>
<p begin="00:01:47.849" end="00:01:50.586" style="s2">In the next brief video,</p>
<p begin="00:01:50.586" end="00:01:54.223" style="s2">the needle is seen deep<br />to the Median Nerve,</p>
<p begin="00:01:54.223" end="00:01:55.940" style="s2">so the nerve is here.</p>
<p begin="00:01:55.940" end="00:01:59.976" style="s2">And the needle can be seen underneath it</p>
<p begin="00:01:59.976" end="00:02:00.809" style="s2">and again,</p>
<p begin="00:02:02.130" end="00:02:06.297" style="s2">injection with Lidocaine<br />and steroid is performed.</p>
<p begin="00:02:08.629" end="00:02:11.443" style="s2">The other approach that some people use</p>
<p begin="00:02:11.443" end="00:02:14.836" style="s2">is with the transducer longitudinal.</p>
<p begin="00:02:14.836" end="00:02:18.183" style="s2">Here's the Median Nerve on the screen.</p>
<p begin="00:02:18.183" end="00:02:22.586" style="s2">And you can approach the<br />Median Nerve this way,</p>
<p begin="00:02:22.586" end="00:02:24.419" style="s2">so distal to proximal.</p>
Brightcove ID
5751328524001
https://youtube.com/watch?v=sxNqVWDwmd0