<p begin="00:00:07.461" end="00:00:09.290" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.290" end="00:00:11.314" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.314" end="00:00:13.933" style="s2">is used to perform an<br />ultrasound examination</p>
<p begin="00:00:13.933" end="00:00:16.052" style="s2">of the ilio-tibial band.</p>
<p begin="00:00:16.052" end="00:00:18.213" style="s2">The patient is in a supine position</p>
<p begin="00:00:18.213" end="00:00:20.812" style="s2">with the knee flexed 90 degrees.</p>
<p begin="00:00:20.812" end="00:00:23.354" style="s2">The transducer is placed longitudinally</p>
<p begin="00:00:23.354" end="00:00:26.365" style="s2">over the outer knee,<br />just proximal and medial</p>
<p begin="00:00:26.365" end="00:00:28.860" style="s2">to the fibular head at Gerdy's tubercle,</p>
<p begin="00:00:28.860" end="00:00:30.647" style="s2">with the orientation marker directed</p>
<p begin="00:00:30.647" end="00:00:32.635" style="s2">to the patient's head.</p>
<p begin="00:00:32.635" end="00:00:34.734" style="s2">The fibers of the ilio-tibial band</p>
<p begin="00:00:34.734" end="00:00:36.838" style="s2">are seen just superficial to the bright,</p>
<p begin="00:00:36.838" end="00:00:39.016" style="s2">hyperechoic Gerdy's tubercle.</p>
<p begin="00:00:39.016" end="00:00:41.254" style="s2">The ilio-tibial band is assessed</p>
<p begin="00:00:41.254" end="00:00:44.324" style="s2">as it cross the lateral femoral condyle.</p>
<p begin="00:00:44.324" end="00:00:47.169" style="s2">A small anechoic bursa may<br />be visible at this point</p>
<p begin="00:00:47.169" end="00:00:50.752" style="s2">in patients with<br />ilio-tibial band syndrome.</p>

<p begin="00:00:07.379" end="00:00:09.137" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.137" end="00:00:11.666" style="s2">with a nerve exam type is used to perform</p>
<p begin="00:00:11.666" end="00:00:14.865" style="s2">a median and ulnar regional nerve block.</p>
<p begin="00:00:14.865" end="00:00:18.167" style="s2">The target depth is approximately<br />one to two centimeters</p>
<p begin="00:00:18.167" end="00:00:20.392" style="s2">in an 80-kilogram adult.</p>
<p begin="00:00:20.392" end="00:00:23.105" style="s2">The patient is placed supine with the arm</p>
<p begin="00:00:23.105" end="00:00:25.641" style="s2">externally rotated at the side.</p>
<p begin="00:00:25.641" end="00:00:28.475" style="s2">The transducer is placed<br />in a transverse plane</p>
<p begin="00:00:28.475" end="00:00:29.721" style="s2">at the wrist crease</p>
<p begin="00:00:29.721" end="00:00:31.120" style="s2">with the orientation marker</p>
<p begin="00:00:31.120" end="00:00:33.953" style="s2">directed towards the patient's right side.</p>
<p begin="00:00:33.953" end="00:00:38.214" style="s2">The hypoechoic pulsatile<br />ulnar artery is identified.</p>
<p begin="00:00:38.214" end="00:00:40.485" style="s2">It may be helpful to use color Doppler</p>
<p begin="00:00:40.485" end="00:00:42.265" style="s2">if the artery is small.</p>
<p begin="00:00:42.265" end="00:00:45.357" style="s2">The ulnar nerve is an oval, or triangular,</p>
<p begin="00:00:45.357" end="00:00:47.294" style="s2">bright, hyperechoic structure</p>
<p begin="00:00:47.294" end="00:00:50.318" style="s2">that lies immediately<br />medial to the artery.</p>
<p begin="00:00:50.318" end="00:00:52.141" style="s2">Trace the nerve up the forearm</p>
<p begin="00:00:52.141" end="00:00:54.392" style="s2">following the course of the artery.</p>
<p begin="00:00:54.392" end="00:00:57.527" style="s2">The ulnar nerve will start<br />to separate from the artery</p>
<p begin="00:00:57.527" end="00:01:00.689" style="s2">approximately 2/3 of<br />the way up the forearm.</p>
<p begin="00:01:00.689" end="00:01:03.902" style="s2">The separation allows safe<br />placement of local anesthetic</p>
<p begin="00:01:03.902" end="00:01:05.269" style="s2">around the nerve.</p>
<p begin="00:01:05.269" end="00:01:07.372" style="s2">Follow the fascial plane medially</p>
<p begin="00:01:07.372" end="00:01:10.376" style="s2">to the superficial and deep flexor muscles</p>
<p begin="00:01:10.376" end="00:01:14.030" style="s2">to identify the bright,<br />hyperechoic median nerve.</p>
<p begin="00:01:14.030" end="00:01:17.358" style="s2">The median nerve appears<br />as an oval, or triangular,</p>
<p begin="00:01:17.358" end="00:01:20.735" style="s2">bright, hyperechoic structure<br />between the muscles.</p>
<p begin="00:01:20.735" end="00:01:22.051" style="s2">The needle can be advanced</p>
<p begin="00:01:22.051" end="00:01:25.372" style="s2">using an in-plane or<br />out-of-plane technique.</p>
<p begin="00:01:25.372" end="00:01:28.332" style="s2">For an in-plane approach,<br />the needle is positioned</p>
<p begin="00:01:28.332" end="00:01:31.655" style="s2">one to two centimeters<br />lateral to the transducer</p>
<p begin="00:01:31.655" end="00:01:34.231" style="s2">and advanced under the transducer.</p>
<p begin="00:01:34.231" end="00:01:37.655" style="s2">The initial path for the needle<br />is toward the ulnar nerve</p>
<p begin="00:01:37.655" end="00:01:38.812" style="s2">to allow the needle tip</p>
<p begin="00:01:38.812" end="00:01:41.893" style="s2">to lie immediately beside the ulnar nerve.</p>
<p begin="00:01:41.893" end="00:01:45.441" style="s2">Inject three to five<br />cc of local anesthetic</p>
<p begin="00:01:45.441" end="00:01:48.604" style="s2">around the ulnar nerve<br />to perform the block.</p>
<p begin="00:01:48.604" end="00:01:52.681" style="s2">The needle is then redirected<br />laterally to the median nerve.</p>
<p begin="00:01:52.681" end="00:01:56.245" style="s2">Injection of three to five<br />cc of local anesthetic</p>
<p begin="00:01:56.245" end="00:01:57.726" style="s2">around the median nerve</p>
<p begin="00:01:57.726" end="00:02:00.809" style="s2">will complete the median nerve block.</p>

<p begin="00:00:09.598" end="00:00:13.480" style="s2">- The next structure to<br />examine is the iliotibial band.</p>
<p begin="00:00:13.480" end="00:00:15.787" style="s2">The iliotibial band attaches distally</p>
<p begin="00:00:15.787" end="00:00:18.519" style="s2">at the Gerdy's tubercle.</p>
<p begin="00:00:18.519" end="00:00:21.179" style="s2">This injury is commonly<br />involved in active individuals,</p>
<p begin="00:00:21.179" end="00:00:23.043" style="s2">including runners.</p>
<p begin="00:00:23.043" end="00:00:25.462" style="s2">Important landmarks in the<br />transducer will always face</p>
<p begin="00:00:25.462" end="00:00:27.444" style="s2">superior with the notch.</p>
<p begin="00:00:27.444" end="00:00:30.242" style="s2">Secondly, to palpate Gerdy's tubercle,</p>
<p begin="00:00:30.242" end="00:00:32.575" style="s2">I begin at the fibular head.</p>
<p begin="00:00:34.524" end="00:00:37.857" style="s2">I move medially until I<br />feel a bony protuberance,</p>
<p begin="00:00:37.857" end="00:00:39.602" style="s2">which is the Gerdy's tubercle.</p>
<p begin="00:00:39.602" end="00:00:43.769" style="s2">I'm going to place the probe<br />directly over Gerdy's tubercle.</p>
<p begin="00:00:45.751" end="00:00:49.916" style="s2">Here I see the fibers<br />of the iliotibial band,</p>
<p begin="00:00:49.916" end="00:00:52.335" style="s2">attaching on Gerdy's tubercle.</p>
<p begin="00:00:52.335" end="00:00:55.502" style="s2">An ultrasound bone is bright white due</p>
<p begin="00:00:57.098" end="00:00:59.181" style="s2">to its reflective nature.</p>
<p begin="00:01:00.201" end="00:01:04.368" style="s2">This is a clear image showing<br />a healthy iliotibial band.</p>