<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>

<p begin="00:00:07.204" end="00:00:08.813" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:08.813" end="00:00:11.101" style="s2">with a superficial venous exam type</p>
<p begin="00:00:11.101" end="00:00:13.364" style="s2">is used to perform an ultrasound guided</p>
<p begin="00:00:13.364" end="00:00:15.289" style="s2">drainage of an abscess.</p>
<p begin="00:00:15.289" end="00:00:18.603" style="s2">The transducer is placed<br />in a longitudinal direction</p>
<p begin="00:00:18.603" end="00:00:21.380" style="s2">over the area of tenderness or fluctuance,</p>
<p begin="00:00:21.380" end="00:00:23.098" style="s2">with the orientation marker directed</p>
<p begin="00:00:23.098" end="00:00:24.780" style="s2">toward the patient's head.</p>
<p begin="00:00:24.780" end="00:00:27.090" style="s2">It is helpful to have a<br />generous amount of gel</p>
<p begin="00:00:27.090" end="00:00:30.651" style="s2">on the transducer face, to<br />decrease transducer pressure</p>
<p begin="00:00:30.651" end="00:00:33.171" style="s2">and pain with the examination.</p>
<p begin="00:00:33.171" end="00:00:35.625" style="s2">The depth and extent of the abscess cavity</p>
<p begin="00:00:35.625" end="00:00:37.445" style="s2">is determined by scanning the cavity</p>
<p begin="00:00:37.445" end="00:00:39.281" style="s2">in a left-to-right direction.</p>
<p begin="00:00:39.281" end="00:00:42.033" style="s2">Septation of the abscess<br />cavity should be determined</p>
<p begin="00:00:42.033" end="00:00:43.879" style="s2">as it is important to free these areas</p>
<p begin="00:00:43.879" end="00:00:46.948" style="s2">during the drainage procedure<br />for optimal results.</p>
<p begin="00:00:46.948" end="00:00:50.132" style="s2">The superior and inferior<br />extent of the abscess cavity</p>
<p begin="00:00:50.132" end="00:00:52.593" style="s2">can be determined by moving the transducer</p>
<p begin="00:00:52.593" end="00:00:55.357" style="s2">in a superior to inferior direction.</p>
<p begin="00:00:55.357" end="00:00:57.394" style="s2">The drainage incision should be planned</p>
<p begin="00:00:57.394" end="00:01:00.730" style="s2">at an area where the abscess<br />cavity is most superficial</p>
<p begin="00:01:00.730" end="00:01:04.147" style="s2">and likely to promote dependent drainage.</p>