Lung Point

- [Voiceover] A linear array transducer
with a musculoskeletal exam type
is used to perform an ultrasound examination
of the metatarsal phalangeal joint in the foot.
The patient is placed in a supine position,
with the knee flexed and the foot on the bed.
The transducer is placed over the dorsal surface
of the metatarsal phalangeal joint
in a longitudinal fashion,
with the orientation marker directed
toward the patient's head.
The metatarsal head is seen
as a bright, hyperechoic rounded structure.
The proximal phalanx can be seen
as a hyperechoic linear structure,
just distal to the metatarsal.
The extensor tendon lies above the bony structures,
and appears as a hyperechoic fibrillar structure.
The metatarsal phalangeal joint can be seen
as a dark hypoechoic region between the metatarsal head
and the first phalanx.
The transducer should be slowly moved
along the medial surface of the metatarsal phalangeal joint
to evaluate the joint space.
The transducer is rotated 90 degrees counterclockwise
to obtain a transverse view.
The extensor tendon appears as an elliptical structure
above the metatarsal head.
The transducer should be slowly moved
to allow a full view of the metatarsal phalangeal joint.

Brightcove ID

5751488312001

https://youtube.com/watch?v=Wb6gFe_TZZw

How to: Pneumothorax Evaluation

Read more about How to: Pneumothorax Evaluation

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Learn transthoracic lung ultrasound to rule out pneumothorax.

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How To Videos

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Subtitles

- Classically, it's been thought
that the lung cannot be ultrasounded.
In fact, that's not true.
We can use ultrasound very easily
to rule out a pneumothorax.
I'm gonna show you, using two different transducers,
how we can see the lung pleural line
to exclude the presence of a pneumothorax.
We're gonna start with our transducers.
We have two different choices of transducers.
We have our phased array transducer
and a linear array transducer.
If you're doing this as part of the fast exam,
most likely you've already have
a phased array transducer in your hand.
Therefore, I'm gonna go ahead
and show you what the images look like
using a phased array transducer.
The exam type has already been set up
in an abdominal preset,
and so we're ready to start scanning.
Now the area that we're gonna scan
is an area where we're gonna expect air to collect
in the presence of a pneumothorax.
That would be the most anterior aspect of the lung.
So if you look at our model right here,
we would expect air to collect more likely
in the anterior surface than more posteriorly.
Therefore, when I do my scanning,
I'm gonna scan about mid-clavicular line
at the most anterior area of the patient's body.
So we're gonna go ahead and start scanning.
Here's our probe marker right here.
We're gonna aim that toward the patient's head,
and I'm scanning right now in a sagittal fashion.
I'm gonna turn my gain up a little bit,
and first thing you're gonna recognize
that our depth is too deep.
Remember, what we're scanning now is really superficial.
We're looking at the lung's surface.
So I'm gonna decrease our depth
so we can see the lung surface quite easily.
Now what we're looking at here on the screen
is a classic shimmering line
that you see with the pleural surface,
that being the parietal and the visceral pleural surface
rubbing against each other.
So we see a rib here on the left.
We see another rib to the right.
And in the center is a line which is horizontal,
and we see shimmering.
That presence of that shimmering,
as well as very small, tiny comet tails
that are coming from the posterior aspect of that,
excludes the presence of a pneumothorax.
If you have time,
you want to use your linear array transducer.
This transducer does high-frequency imaging,
allows you to do much better imaging
of superficial structures.
So we're gonna get a lot better quality,
high-resolution pictures, of the pleural line.
So here's our transducer that I've chosen.
This is the marker here right now.
And I'm gonna go ahead and put a little gel here.
Now I'm gonna cut sagittally
at the highest point in his chest,
in about the mid-clavicular line,
and I notice to the left of the screen
is a rib right here,
and we see another rib right here.
And in between the two, we see the pleural line.
And as he takes a breath, we see shimmering.
These are the two surfaces of the lung,
the visceral surface and the parietal surface,
rubbing together.
We also see little tiny white lines,
your little comet tail lines,
which also show that both surfaces are touching together.
If you see this pattern,
you have reliably excluded a pneumothorax.
You can see in this model
that we can easily see the rib here anteriorly
and another one more inferiorly,
and we see the pleural line easily here in the middle,
we see shimmering.
Now you may want to document this in a still pattern.
That is very easy to do by just activating the M-mode.
We hit the M-mode key here.
And we put the M-mode marker
through the center of the pleural line
where we see shimmering, and with M-mode again.
And what we see now is a pattern
that's called the seashore sign.
And I'm gonna freeze this.
So now we have a frozen image
of the M-mode through the pleural line,
and we see the shimmering line here,
and we see here a classic seashore sign.
And when you see this,
this is still documentation of exclusion of a pneumothorax.
If you do your exam in the mid-clavicular line
at the most anterior portion of the chest,
and you see a good shimmering line,
then you've ruled out a pneumothorax.
If you don't see any shimmering line,
then you most likely are dealing
with a patient with a pneumothorax.
You can then take your transducer
and move it to the patient's left or to his right
or in more superior and inferior
to get a qualitative size of the pneumothorax
you're dealing with.

Brightcove ID

5741746210001

https://youtube.com/watch?v=D3mm9wwlw7g

Hand: MCP Joint Injection

Read more about Hand: MCP Joint Injection

3D How To: Lung Examination

Read more about 3D How To: Lung Examination

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3D animation demonstrating a lung ultrasound exam.

Applications

Cardiology

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How To Videos

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Subtitles

- [Voiceover] A phased array transducer
with a long exam type is used to evaluate lung sliding.
The anterior, lateral, and posterior zones of the chest wall
should be evaluated.
The transducer is placed in a long-axis orientation
over the anterior chest wall at the third or fourth
intercostal space in the anterior axillary line.
The orientation marker is directed to the patient's head.
A shallow scanning depth is used.
The ribs are identified in the near field of the image
as a bright interface with a posterior shadow.
The pleural line is identified as a bright,
hyperechoic line between the rib shadows.
The to and fro sliding movement of the visceral pleural
against the parietal pleural with breathing
generates the lung sliding sign.
Evaluate the pleural movement for A line and B line
reverberation artifacts.
To evaluate the posterior pleural space,
move the transducer distally to the level
of the seventh intercostal space.
Slide the transducer posteriorly to the midaxillary line.
Increase the scanning depth to view the interface
between the pleural space and diaphragm.
In a normal patient, a mirror image artifact
of the liver or spleen will appear the diaphragm.

Brightcove ID

5741728173001

https://youtube.com/watch?v=LnqxLEbsTZY

3D How To: eFAST Lung Sliding Detection (Phased)

Read more about 3D How To: eFAST Lung Sliding Detection (Phased)

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3D animation demonstrating how to detect lung sliding with a phased array transducer while performing the eFAST exam.

Applications

Cardiology

Clinical Specialties

Cardiology

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How To Videos

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Subtitles

- [Voiceover] A phased array transducer is used
to evaluate lung sliding as an extension of the FAST exam.
The orientation marker is positioned
in the direction of the patient's head.
The transducer is placed in a long-axis orientation
over the anterior chest wall at the third
or fourth intercostal space
in the anterior axillary or midclavicular line.
A superficial scanning depth is used.
The ribs are identified in the near field of the image
as a bright interface with a posterior shadow.
The pleural line is identified
as a bright hyperechoic line between the rib shadows.
The normal to and fro sliding movement
of the visceral pleural against the parietal pleural
with breathing generates the lung sliding sign.
If desired, the delineation of the lung sliding interface
may be enhanced by changing to a linear array transducer.

Brightcove ID

5753042634001

https://youtube.com/watch?v=n9J12nmNhUU

How To Detect Lung Sliding with Ultrasound

Read more about How To Detect Lung Sliding with Ultrasound

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3D animation demonstrating how to detect lung sliding with a linear transducer while performing the eFAST exam.

Applications

Cardiology

Media Library Type

How To Videos

Media Library Tag

Subtitles

- [Voiceover] A linear array transducer is used
to evaluate lung sliding as an extension of the FAST exam.
The orientation marker is positioned in the direction
of the patient's head.
The transducer is placed in a long access orientation
over the anterior chest wall
at the third or fourth intercostal space
in the interior axillary to mid-clavicular line.
The ribs are identified in the near field of the image
as bright interface with a posterior shadow.
The plural line is identified
as a bright hyperechoic line between the rib shadows.
The to and fro sliding movement of the visceral plural
against the parietal plural with breathing
generates the lung sliding sign.

Brightcove ID

5741746239001

https://youtube.com/watch?v=26RQyxk5vGc

Body

3D animation demonstrating how to detect lung sliding with a linear transducer while performing the eFAST exam.

Case: Ultrasound for Pneumothorax

Read more about Case: Ultrasound for Pneumothorax

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The video demonstrates how to use long and short axis configurations, as well as M-mode, to detect and diagnose both a complete and partial pheumothorax.

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Case Study Videos

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Subtitles

- Hello, my name is Phil Perera,
and I'm the Emergency Ultrasound Coordinator
at the New York Presbyterian Hospital in New York City.
And welcome to SoundBytes Cases.
In this module we're going to look specifically
at Ultrasound of the Lung to Evaluate for Pneumothorax.
Interestingly enough,
a classical belief was that the lung was not optimal
for ultrasound imaging.
However newer findings have shown
that actually ultrasound is an excellent modality
for viewing the pleura and for detecting pnemothoraces.
There's been a lot of research looking at this
and what's interesting is that ultrasound
has been found now to be more sensitive than chest X-ray
in the diagnosis of pneumothorax especially
in the supine trauma patient.
And now we're going to add on views of the lungs
looking for pneumothorax as part
of our Extended FAST Exam,
or the E-FAST exam that we'll be performing
in trauma patients.
We can also detect pneumothoraces as well
in our medical patients.
Now let's learn how to perform the ultrasound examination
for the pneumothorax detection.
Here we have the high frequency linear type array probe
positioned on the anterior chest wall
at about the midclavicular line
looking in to about intercostal space three.
Now in most cases of pneumothorax with the patient supine
the air would be predominantly seen in this area.
Note we're looking in a long axis configuration
between the ribs with the marker dot
oriented superiorly towards the patient's head.
Once we've identified both the ribs and the pleura
we can swivel the probe into the short axis configuration
to further look at the pleura
and to detect pneumothorax.
Here we have the probe oriented in a transverse
or short axis orientation between the ribs
looking directly down at the pleura.
Notice in this case the marker dot is located
towards the lateral aspect of the patient.
Using both long and short axis configurations
will allow you to detect a pneumothorax
with a high degree of accuracy.
If no lung is seen on the anterior chest wall
one can size out a pneumothorax
by looking in the lateral positions as shown here.
Notice the probe on the lateral chest wall
in the short axis configuration between the ribs.
If lung is seen here laterally but not anteriorly,
this would tell you it was an incomplete pneumothorax.
We can complement the short axis view
by locating the probe into the long axis configuration
with the marker dot towards the patient's axilla
to further examine into these lateral areas
of the chest wall.
Here's a nice pictorial showing
the normal findings of a lung
in a long axis type configuration.
Superior rib to the left,
inferior rib to the right.
Notice that the ribs cast shadows posteriorly
due to the inability of the soundwaves
to permeate the hard calcifications of the rib.
We see the chest wall anteriorly,
and note here the two layers of the pleura.
And we see here the outer parietal pleura,
and the inner visceral pleura.
Now while I've depicted these as two separate layers,
in reality on ultrasound examination
they're seen as a single shimmering white line
that moves back and forth as the patient breathes.
And as the patient breathes we can see white comet tails,
or linear lines, vertical lines,
coming off the pleura down deep into the lung.
So that will be the normal finding of a lung
on long axis configuration.
Here's a nice ultrasound image
showing a normal lung
and what we see here,
we're in the long axis configuration,
so the superior rib is to the left,
inferior rib to the right.
Chest wall anteriorly,
and we see here the lung sliding
which is the opposition of the outer parietal
and the inner visceral pleura.
And we see the vertical comet tails
coming off the back of the pleura.
Thus this is a completely normal exam.
No pneumothorax.
But note the location of the pleura deep to the ribs,
and that classic shimmering line back and forth
as the patient takes a breath.
Here we see more dramatic comet tails
coming off the shimmering parietal and visceral pleura.
In this patient we see the comet tails
shooting off the back,
telling us that this lung is up and there's no pneumothorax.
So vertical lines coming off the back of the pleura
always mean that the lung is up and are always a good sign
on lung ultrasound sonography.
As we mentioned we should also swivel the probe
into the short axis configuration
to further examine the lung,
and what we see here is a normal lung
in short axis configuration.
Note here we're looking in between the ribs
so all we see is the dome of the lung
and notice that it slides back and forth
as the patient breathes,
and we see the vertical comet tails
coming off the back.
So a completely normal examination in the short axis plane.
Here's another ultrasound image
taken from the short axis configuration.
Note here we see very prominent comet tails
coming off the back of the lung as it slides back and forth.
Again it's that opposition
of the parietal and visceral layers of the pleura
that allow the lung shimmering,
but notice here all the comet tails coming off the back.
In this case this patient had some pulmonary edema
associated with the lung
and these comet tails are more pronounced
due to the presence of water within the pleura.
But notice all these vertical lines coming off the back
telling us this lung is up.
A way to document that the lung is up
to print out for the chart is to put M-Mode,
and generally what we do is locate it so the M-Mode cursor
is down right at the pleura.
And what we see is the classic seashore sign,
or waves on the beach.
If we look anteriorly we'll see the classic waves,
or no motion of the chest wall,
and below that,
deep to the pleura we'll see the positive motion of the lung
making up the beach.
So waves on the beach,
or the seashore sign,
and M-Mode documentation that the lung is up
and that there's no pneumothorax.
Now that we understand what a normal lung looks like
on bedside examination,
let's take a look at a pictorial showing a pneumothorax
in a long axis view.
We see here that the parietal pleura
is now split from the visceral pleura,
which is attached to the lung
by a layer of air shown by the yellow color.
It's the splitting of the parietal and visceral pleura
that now causes a lack of lung sliding.
And instead of the opposed visceral and parietal pleura
sliding back and forth as the patient breathes,
all we see is a single line,
the parietal pleura,
with a lack of vertical comet tails coming off the back.
Here's an ultrasound image taken from a patient
who was stabbed to the left chest
and who had shortness of breath.
What we see here is a long axis view of a pneumothorax.
Let's take a look at the chest wall anteriorly,
and right below that we see the parietal pleura,
the single white line located directly inferior to the ribs.
But notice the classic lack of the lung sliding.
All we see here is a single white line
that fails to slide back and forth as the patient breathes.
Notice also the absence of the vertical comet tails.
Here's another image of a pneumothorax
in a long axis configuration,
and we see here the chest wall anteriorly,
and the single white line which is the parietal pleura.
Now this patient was acutely dyspneic,
so notice that there is some motion of the chest wall
and that the parietal pleura moves up and down,
but notice the failure of horizontal sliding.
Notice also the absence of any vertical comet tails
coming off the back of the pleura.
Now let's inspect a pneumothorax from the short axis view.
We see the chest wall anteriorly,
the parietal pleura as shown as a single,
non-mobile white line in the middle of the image.
Note the failure of movement back and forth,
the lack of vertical comet tails,
and what we see here is repeating horizontal air lines
from the pneumothorax.
To document the absence of lung sliding
and the presence of a pneumothorax,
we'll again turn to M-Mode.
If we put the M-Mode cursor down on the pleura,
what we'll see is a set of linear repeating lines.
This documents no motion of both the chest wall
and of the lung,
making up a finding known as the bar code sign.
Here's a pictorial showing interesting finding.
The signature of an incomplete pneumothorax,
known as lead point.
And what we see is an incomplete pneumothorax
with air collecting to the superior aspect
of the image to the left.
Thus splitting the parietal from the visceral layers
and causing an absence of lung sliding superiorly.
However, as the lung is coming up against the chest wall
to the right or inferiorly,
that's where we'll see the presence
of horizontal lung sliding,
and the presence of the vertical comet tails.
Here's an ultrasound image showing the lead point,
and what we see here is the lung sliding to the right,
the area where the lung touches up against the chest wall,
and to the left the area of absence of lung sliding
telling you there that air has collected
between the visceral and parietal layers.
So the ultrasound equivalent of the image
that we just looked at telling you
that this is an incomplete pneumothorax.
But here we see that lead point,
or transition point,
very well on bedside sonography.
In conclusion I'm glad I could share with you
this ultrasound module going over ultrasound of the lung
to evaluate for pneumothorax.
This is an excellent tool for viewing the pleura
and making the diagnosis of pneumothorax,
and there's been some research showing that it may be
more sensitive than chest X-ray in the diagnosis
of pneumothorax,
allowing rapid diagnosis of pneumo
in both your trauma and medical patient,
thus facilitating more timely management
of these most critical patients.
So I hope to see you back as SoundBytes continues.

Brightcove ID

5508134309001

https://youtube.com/watch?v=Xxdedx1HtHo

How To: Wrist Injection

Read more about How To: Wrist Injection

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Dr. Scott Pollock demonstrates how to perform an ultrasound guided wrist injection.

Clinical Specialties

Physical Med & Rehab

Media Library Type

How To Videos

Media Library Tag

Msk Ultrasound

Musculoskeletal Ultrasound

Hand

Wrist

Extensor Tendon

Metacarpophalangeal Joint

Rheumatology Ultrasound

Rheumatoid Ultrasound

Synovial Prolipheration

Subtitles

- This is a demonstration only for injecting
the Median Nerve, placing steroids into the carpal tunnel.
So, I'm not using sterile technique,
sterile gel or cleansing the area.
This is for demonstration purposes only.
And I am going to be doing an injection in this direction.
Again, I am going to be placing the needle
parallel to the transducer.
Apply some gel here.
By placing the transducer transversely,
I have in the middle of the screen, the Median Nerve.
I can find
the Ulnar Artery on this side.
And you can see it pulsating.
I mark the Ulnar Artery with an indelible pen.
And then move just a little bit to the radial side,
so that the Ulnar Artery is down here.
And place a 25 gauge needle
in this direction, very superficially,
because it's only two millimeters deep.
And bring that needle in from the left side of the screen.
In this image, the Median Nerve is sitting right here.
The Retinaculum is along this surface here.
And the needle is coming in
from the left side of the screen.
This is bone down here.
You'll see the needle advanced superficial to
the nerve and fluid,
which includes steroids and Lidocaine injected.
In the next brief video,
the needle is seen deep to the Median Nerve,
so the nerve is here.
And the needle can be seen underneath it
and again,
injection with Lidocaine and steroid is performed.
The other approach that some people use
is with the transducer longitudinal.
Here's the Median Nerve on the screen.
And you can approach the Median Nerve this way,
so distal to proximal.

Brightcove ID

5751328524001

https://youtube.com/watch?v=sxNqVWDwmd0

How To: Wrist Exam

Read more about How To: Wrist Exam

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Dr. Scott Pollock demonstrates how to perform a wrist exam.

Clinical Specialties

Media Library Type

Media Library Tag

Metacarpophalangeal Joint

Msk Ultrasound

Musculoskeletal Ultrasound

Rheumatoid Arthritis

Rheumatoid Ultrasound

Rheumatology

Rheumatology Ultrasound

Synovial Prolipheration

Subtitles

- We're going to examine the wrist today,
and the best transducer for this examination
is the L25, the small footprint.
We'll check that the exam type is correct.
We're doing an MSK type of exam.
For orientation, there is a marker here which
corresponds to the turquoise dot on the screen.
Keep this marker proximal when I'm examining longitudinally
and medial when I'm examining transversally.
We'll start the wrist on the dorsal surface
and examine transversally first.
There are six compartments, beginning with
the first compartment at the base of the thumb,
and the sixth compartment near the ulnar styloid.
When we look at the wrist structures,
we're looking not only at tendons and bones,
but we're also looking at a multitude of joints.
If I come over here to a middle portion,
we're looking at carpal bones here.
With the presence of synovitis,
we would have hyperechoic or anechoic fluid
and thickening of synovium at these recesses,
which are the joints.
None of that is present here.
We'll move over to the extensor tendons of the thumb,
where you can sometimes see de Quervain's tenosynovitis,
and here is a nice view of one of
the long tendons of the thumb.
These extensor digitorum tendons here
are normal in appearance on cross-section.
These are the two thumb tendons that you see
right over the distal end of the radius,
which is right here.
This then can be traced distally out toward the thumb,
and these tendons and their peritendinous tissue
can be examined carefully.
On the other side of the wrist toward the ulna,
we have a very nice view of the
extensor carpi ulnaris tendon, which is
one of the largest extensor tendons in the wrist
and easiest to see.
It also is frequently surrounded, in a patient
with an inflammatory process, with fluid
or synovium, and that can be seen as either
anechoic or hyperechoic shadow around the
distinct oval-shaped tendon, which is
hyperechoic, and you can see the fibrillar nature within it.
If we look longitudinally, keeping this dot proximal,
and find that extensor carpi ulnaris tendon,
you can see these parallel lines,
which are going from left to right.
There are areas that are hyperechoic
alternating with hypoechoic.
This is a normal appearance of the tendon,
and also visualize peritendonous tissue.
The retinaculum, which is up here,
in deep to this, this is the distal part of the ulna.
First part of carpal bones,
and triangular ligament is in here.
Next, we look at the volar, or palmer surface of the wrist.
Most of the time, we're going to be
looking at the median nerve in this area.
Again, the transducer marker is placed medially.
This structure here is the median nerve.
We can go toward the radial side and see the artery,
the hyperechoic or anechoic area that has a small pulsation.
Sometimes checking color Doppler signal
or Doppler signal is helpful, and the median nerve, then,
is seen right here in the middle.
On the ulnar surface, going in this direction,
is the ulnar artery, and we can freeze the image
and take a measurement of the median nerve
if it's desired to see whether this is enlarged
using direct correlation between this measurement
and the presence of carpal tunnel syndrome.
So I have placed my calipers on both sides
of the median nerve, just inside the perineurium,
and then I'm going to hit this ellipse button.
Then I can actually take an approximate surface area.
She has a .08 centimeter squared area, which is normal,
and so by ultrasound criteria does not have
carpal tunnel syndrome.

Brightcove ID

5508120239001

https://youtube.com/watch?v=txMGtvWb2XI

How To: Ultrasound Guided Hand Injection

Read more about How To: Ultrasound Guided Hand Injection

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Dr. Scott Pollock demonstrates how to perform an ultrasound guided hand injection.

Clinical Specialties

Physical Med & Rehab

Media Library Type

How To Videos

Media Library Tag

Msk Ultrasound

Musculoskeletal Ultrasound

Hand

Wrist

Extensor Tendon

Metacarpophalangeal Joint

Rheumatology Ultrasound

Rheumatoid Ultrasound

Subtitles

- So I'm going to show a technique for injection of fingers,
and we'll do on the Dorsal surface or Extensor surface,
a simulation of injection of either a PIP or MCP joint
and then turn the hand around on the Palmar surface,
and show you an injection approach for Flexor tendons.
I'm gonna use the L25 transducer.
Normally we would be dealing with a sterile field,
and a sterile gel, and most likely a transducer cover,
which is also sterile, but for the purposes of this,
we're just showing you an approach.
If the joint is swollen and has Synovitis,
or a joint diffusion, it's quite easy to see the space
that you're aiming for.
This particular exam, we don't have that finding.
Normally for an injection into a small joint like this,
I like to approach the joint with the transducer placed
transversely, in this type of a plane, and then have
the needle in the same direction parallel, or in plane
with the transducer, so my needle and my transducer are
parallel, and I'm going as superficial as possible,
with a very small needle so it doesn't hurt,
and trying to place the needle into the skin,
and in the one millimeter ultrasound beam,
into the target this way.
On the other side, we'll be looking at a Flexor tendon,
which travels in this direction.
I will place the transducer longitudinally,
and approach with the needle in this direction.
If you keep the needle parallel to the surface
of the transducer, it shows up the best.
The insertion point can be quite close
to the transducer's edge, especially if you're going
very superficially; in a small area like a finger,
or a tendon around here, you don't have a lot of space
and so you have to go very close, and can insert
the needle very flat and superficially.
Because there's very little space between the skin surface
and the tendon, and here it's probably
about two or three millimeters.
And watch exactly where the tip of the needle
and the bevel goes.

Brightcove ID

5751328215001

https://youtube.com/watch?v=cdXuffySPJI

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3D How To: Foot Exam: MTP Joint

3D How To: Foot Exam: MTP Joint

How to: Pneumothorax Evaluation

How to: Pneumothorax Evaluation

Hand: MCP Joint Injection

Hand: MCP Joint Injection

3D How To: Lung Examination

3D How To: Lung Examination

3D How To: eFAST Lung Sliding Detection (Phased)

3D How To: eFAST Lung Sliding Detection (Phased)

How To Detect Lung Sliding with Ultrasound

How To Detect Lung Sliding with Ultrasound

Case: Ultrasound for Pneumothorax

Case: Ultrasound for Pneumothorax

How To: Wrist Injection

How To: Wrist Injection

How To: Wrist Exam

How To: Wrist Exam

How To: Ultrasound Guided Hand Injection

How To: Ultrasound Guided Hand Injection

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