<p begin="00:00:07.749" end="00:00:09.332" style="s2">- [Voiceover] A curved array transducer</p>
<p begin="00:00:09.332" end="00:00:11.596" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.596" end="00:00:14.226" style="s2">is used to perform an<br />ultrasound guided injection</p>
<p begin="00:00:14.226" end="00:00:16.908" style="s2">of the proximal hamstring muscle.</p>
<p begin="00:00:16.908" end="00:00:19.168" style="s2">The patient is in a prone position</p>
<p begin="00:00:19.168" end="00:00:21.615" style="s2">with the leg slightly abducted.</p>
<p begin="00:00:21.615" end="00:00:23.978" style="s2">The transducer is place transversely</p>
<p begin="00:00:23.978" end="00:00:26.981" style="s2">over the ischial tuberosity<br />with the orientation marker</p>
<p begin="00:00:26.981" end="00:00:31.148" style="s2">directed to the patient's right<br />at a nine o'clock position.</p>
<p begin="00:00:32.248" end="00:00:34.232" style="s2">The ischial tuberosity is seen</p>
<p begin="00:00:34.232" end="00:00:38.015" style="s2">as a bright, hyperechoic,<br />curved structure.</p>
<p begin="00:00:38.015" end="00:00:40.650" style="s2">The hamstring muscle and<br />it's conjoined tendon</p>
<p begin="00:00:40.650" end="00:00:42.860" style="s2">is seen on cross-section<br />in the mid portion</p>
<p begin="00:00:42.860" end="00:00:44.724" style="s2">of the scan field.</p>
<p begin="00:00:44.724" end="00:00:47.306" style="s2">The transducer is translated superiorly</p>
<p begin="00:00:47.306" end="00:00:50.884" style="s2">to see the origin of the<br />muscle in a short access plane.</p>
<p begin="00:00:50.884" end="00:00:54.152" style="s2">The transducer is then<br />rotated 90 degrees clockwise</p>
<p begin="00:00:54.152" end="00:00:57.279" style="s2">with the orientation marker<br />directed at the patient's head</p>
<p begin="00:00:57.279" end="00:01:00.516" style="s2">to obtain a long access view<br />of the hamstring muscle.</p>
<p begin="00:01:00.516" end="00:01:03.236" style="s2">The needle is inserted<br />in a long access approach</p>
<p begin="00:01:03.236" end="00:01:05.895" style="s2">lateral to the transducer.</p>
<p begin="00:01:05.895" end="00:01:08.374" style="s2">The needle is slowly<br />advanced to lie in plane</p>
<p begin="00:01:08.374" end="00:01:09.936" style="s2">to the transducer beam</p>
<p begin="00:01:09.936" end="00:01:13.804" style="s2">and is seen as a bright,<br />hyperechoic, linear structure.</p>
<p begin="00:01:13.804" end="00:01:14.637" style="s2">The needle is slowly advanced</p>
<p begin="00:01:14.637" end="00:01:17.363" style="s2">under direct ultrasound visualization</p>
<p begin="00:01:17.363" end="00:01:18.670" style="s2">until the tip is seen</p>
<p begin="00:01:18.670" end="00:01:21.824" style="s2">to puncture the anterior<br />surface of the muscle.</p>
<p begin="00:01:21.824" end="00:01:23.070" style="s2">The needle should be advanced</p>
<p begin="00:01:23.070" end="00:01:26.030" style="s2">until the needle tip lies<br />just above the bony surface</p>
<p begin="00:01:26.030" end="00:01:28.270" style="s2">within the conjoined tendon.</p>
<p begin="00:01:28.270" end="00:01:29.983" style="s2">Care should be taken to avoid</p>
<p begin="00:01:29.983" end="00:01:32.236" style="s2">the posterior cutaneous thigh nerve</p>
<p begin="00:01:32.236" end="00:01:35.297" style="s2">which often overlies the conjoined tendon.</p>
<p begin="00:01:35.297" end="00:01:38.047" style="s2">The needle should be aspirated<br />prior to the injection</p>
<p begin="00:01:38.047" end="00:01:39.720" style="s2">of the anesthetic agent.</p>
<p begin="00:01:39.720" end="00:01:41.937" style="s2">At the conclusion of the procedure,</p>
<p begin="00:01:41.937" end="00:01:43.992" style="s2">the hamstring muscle should be scanned</p>
<p begin="00:01:43.992" end="00:01:46.513" style="s2">using a short and long access approach</p>
<p begin="00:01:46.513" end="00:01:50.680" style="s2">to ensure that there is no<br />bleeding following the procedure.</p>

<p begin="00:00:07.639" end="00:00:09.351" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.351" end="00:00:11.510" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.510" end="00:00:14.415" style="s2">is used to perform an<br />ultrasound guided aspiration</p>
<p begin="00:00:14.415" end="00:00:16.039" style="s2">of a Baker's cyst.</p>
<p begin="00:00:16.039" end="00:00:18.528" style="s2">The patient is in a supine position.</p>
<p begin="00:00:18.528" end="00:00:20.870" style="s2">The transducer is placed transversely</p>
<p begin="00:00:20.870" end="00:00:22.752" style="s2">over the popliteal fossa,</p>
<p begin="00:00:22.752" end="00:00:26.088" style="s2">with the orientation marker<br />directed to the patient's right.</p>
<p begin="00:00:26.088" end="00:00:28.820" style="s2">The most common location<br />for a Baker's cyst</p>
<p begin="00:00:28.820" end="00:00:31.767" style="s2">is at the crossing of the<br />semimembranosus muscle</p>
<p begin="00:00:31.767" end="00:00:32.839" style="s2">and the medial head</p>
<p begin="00:00:32.839" end="00:00:36.367" style="s2">of the gastrocnemius muscle<br />above the femoral condyle.</p>
<p begin="00:00:36.367" end="00:00:38.343" style="s2">The femoral condyle is seen as a</p>
<p begin="00:00:38.343" end="00:00:41.719" style="s2">bright hyperechoic structure<br />on the left of the screen.</p>
<p begin="00:00:41.719" end="00:00:43.494" style="s2">The speckled pattern of the tendon</p>
<p begin="00:00:43.494" end="00:00:45.454" style="s2">of the semimembranosus muscle,</p>
<p begin="00:00:45.454" end="00:00:47.718" style="s2">and the starry night<br />appearance of the medial head</p>
<p begin="00:00:47.718" end="00:00:50.591" style="s2">of the gastrocnemius can<br />be seen as the transducer</p>
<p begin="00:00:50.591" end="00:00:52.535" style="s2">is moved more distally.</p>
<p begin="00:00:52.535" end="00:00:54.071" style="s2">A Baker's cyst appears as a</p>
<p begin="00:00:54.071" end="00:00:58.903" style="s2">C-shaped, darker hypoechoic<br />or anechoic cystic structure,</p>
<p begin="00:00:58.903" end="00:01:01.746" style="s2">with a superficial and deep component.</p>
<p begin="00:01:01.746" end="00:01:04.871" style="s2">The transducer is rotated<br />90-degrees clockwise,</p>
<p begin="00:01:04.871" end="00:01:06.143" style="s2">with the orientation marker</p>
<p begin="00:01:06.143" end="00:01:08.472" style="s2">directed toward the patient's head.</p>
<p begin="00:01:08.472" end="00:01:11.095" style="s2">The extent and depth of the Baker's cyst</p>
<p begin="00:01:11.095" end="00:01:12.946" style="s2">should be confirmed by scanning</p>
<p begin="00:01:12.946" end="00:01:15.839" style="s2">the cyst proximally and distally.</p>
<p begin="00:01:15.839" end="00:01:17.806" style="s2">The needle is inserted in the skin</p>
<p begin="00:01:17.806" end="00:01:20.287" style="s2">just proximal to the transducer.</p>
<p begin="00:01:20.287" end="00:01:22.913" style="s2">The needle is slowly<br />advanced to lie in plane</p>
<p begin="00:01:22.913" end="00:01:24.358" style="s2">to the transducer beam,</p>
<p begin="00:01:24.358" end="00:01:28.447" style="s2">and is seen as a bright,<br />hyperechoic linear structure.</p>
<p begin="00:01:28.447" end="00:01:30.041" style="s2">The needle is slowly advanced</p>
<p begin="00:01:30.041" end="00:01:32.262" style="s2">under direct ultrasound visualization,</p>
<p begin="00:01:32.262" end="00:01:33.623" style="s2">until the tip is seen to lie</p>
<p begin="00:01:33.623" end="00:01:35.022" style="s2">within the Baker's cyst,</p>
<p begin="00:01:35.022" end="00:01:37.647" style="s2">where an aspiration can be done.</p>
<p begin="00:01:37.647" end="00:01:39.415" style="s2">After the procedure is finished,</p>
<p begin="00:01:39.415" end="00:01:40.700" style="s2">the area should be scanned</p>
<p begin="00:01:40.700" end="00:01:42.782" style="s2">to ensure that there is<br />no evidence of bleeding</p>
<p begin="00:01:42.782" end="00:01:43.865" style="s2">in this area.</p>