0:01

Now, under ultrasound guidance, the technique that we use is coming from

0:05

anterior. We'll orient the probe almost like a Swiss view, where the probe

0:10

is oriented along the course of the femoral neck. And we're trying to

0:15

position the probe at the region of the femoral head neck junction.

0:19

Then, after we found the proper location, our sonographer will mark that

0:23

location with a T. The T shape tells us that this margin of

0:27

the probe, the distal margin of the probe, as well as the long

0:30

axis of the probe. And then, essentially, the needle will be inserted at

0:35

the T, and it'll follow the orientation of the guide.

0:40

And the guide will direct the needle in this type of a direction

0:43

until the needle collides with the femoral head neck junction.

0:47

Once there's visual confirmation that the needle hits the underlying bone,

0:51

then you could do a test injection, or you could just completely inject

0:55

your fluid and make sure that the joint capsule is lifting up off

0:59

the bone. Just to get oriented, this is the femoral neck right here.

1:04

This is the femoral head neck junction right here.

1:07

This is your femoral head right here. You can't really see it out

1:11

of the field of view as kind of your acetabulum, and your acetabular labrum

1:15

would be somewhere in this location. Not the best look at it here,

1:18

because we're really concentrating on our femoral head and neck.

1:23

So, here's an example under ultrasound, and here's what I mean by the

1:25

needle guide. So, the needle guide's an attachment which basically forces

1:29

your needle into the plane of the ultrasound probe. Before you even put

1:33

the needle in, the ultrasound machine will kind of give you these guidelines

1:37

where the needle will most likely follow. Here you can see the needle

1:41

kind of skewed just a little bit anteriorly. But what's nice about using

1:44

the needle guide is that you're able to see the full course of

1:47

your needle, and your confidence when your needle contacts the bone is very

1:51

strong. So, once you contact the bone with your needle, then you're ready

1:55

to inject the fluid. And in this case, you can see that when

1:58

you're injecting the fluid, you can see that this joint capsule is lifting

2:02

up off the bone because of this anechoic fluid, which is filling the

2:07

hip joint space. And the fluid is actually giving some nice contrast where

2:11

you can even see the cartilage on the femoral head.

2:14

So, this is just a nice example of how to get your needle

2:17

in the proper location at the femoral head neck junction, an area where

2:20

it's kind of curving away from the joint capsule, which is right here,

2:24

maximizing your potential space between the needle tip and the joint capsule.

2:28

And then when you inject the fluid, how the capsule kind of lifts

2:31

off the bone, and you wind up with this anechoic fluid filling the

2:34

joint space.