ISCHIAL SPINE SKIN

Patrick Curry and Steven Faust, MSPT, Discuss Spine Surgery and Physical Therapy Austin Chen and Chelsea Alexander Discuss Hip Arthroscopy and Physical Therapy BCH Lecture: Treatment for Painful Hips and Knees.MakoВ® Robotic-Arm Assisted Total Knee Replacement.MakoВ® Robotic-Arm Assisted Total Hip Replacement.MakoВ® Robotic-Arm Assisted Partial Knee Replacement.Durable Medical Equipment (DME) at The OrthoShop.Wray Community District Hospital & Clinic.Physical Medicine & Rehabilitation Doctor.Ultrasound-guided sciatic nerve block is potentially valuable for achieving clinical anesthesia with fewer attempts and higher success, but this needs confirmation in future studies. Ultrasound identification of deep bony landmarks-ischial spine, ischial tuberosity, and lesser trochanter-provides a consistent guide to the sciatic nerve at these locations. We have demonstrated that a low-frequency ultrasound probe in the range of 2вЂ“5 MHz is valuable in localizing the sciatic nerve in these locations and can visually guide needle advancement to target with precision. 10,13вЂ“17In this study, we have generated unique ultrasound images of the sciatic nerve in deeper locations, i.e.В , the gluteal, infragluteal, and proximal thigh regions. 11,12Previous human and cadaver studies have examined anatomicalвЂ“sonographic correlation of the sciatic nerve, but they are limited to the mid thigh and regions below. ResultsД¬urrently, high-resolution sonography is valuable in the diagnosis of peripheral nerve entrapment syndromes, 9neuropathies, 10and nerve tumors. The pattern of 5% dextrose solution spread, and the threshold stimulating current (mean В± SD) was noted. After electrical stimulation, 10вЂ“20 ml dextrose 5% solution was injected incrementally in 2- to 3-ml aliquots under ultrasound observation to mimic a local anesthetic injection. When the needle was judged to be in satisfactory position, a nerve stimulator with a 100-Ојs pulse duration (Stimuplex Braun Medical, Bethlehem, PA) was turned on to elicit foot plantarflexion or dorsiflexion using a maximum of 1.5 mA. The needle was advanced under real-time ultrasound imaging guidance until it made contact with the target nerve.

ISCHIAL SPINE SKIN

After sterile skin preparation with povidone-iodine and local infiltration with 1% lidocaine, an 8-cm, 22-gauge insulated block needle (Pajunk, Geisingen, Germany) was inserted parallel and inline with the ultrasound probe covered with a sterile plastic cover and gel ( fig. Subsequent electrical stimulation confirmed target sciatic nerve at both locations. That is, each subject received two needle punctures (first, in the ischial spine location in all subjects, and second, in the ischial tuberosity location or the lesser trochanter location according to a computer-generated randomization table). If successful, ultrasound-assisted sciatic nerve block may improve the accuracy of needle placement and local anesthetic injection and decrease failure rate.ДЄfter ultrasound scanning, a block needle was inserted for nerve localization and electrical stimulation in 15 subjects. Therefore, the consistent anatomical relation between the sciatic nerve and its neighboring bony structures (ischial spine, ischial tuberosity, and lesser trochanter) along its course may be valuable anatomical cues for ultrasound localization of the sciatic nerve. When the ultrasound beam encounters bone, the reflected signal generates a linear predominantly hyperechoic (bright) bony density and a hypoechoic (dark) bony shadow underneath. Bones are consistent structures easily identifiable on ultrasound. In principle, ultrasound imaging can also identify the sciatic nerve, which is more prominent in size but deeper in location than the brachial plexus. 7,8Also useful is real-time imaging guidance at the time of needle advancement during ultrasound-assisted nerve block. Ultrasound is a useful tool for localizing the brachial plexus and its branches at different levels along its course.

Ischial spine