Today, I will share a practical ultrasound intervention for plantar fasciitis
after blocking the tibial nerve at the medial ankle.
Let me explain my patient's position.
If you check in some lectures on RU-vid,
you will find that many doctors prefer a patient's supine position
and insert the needle from anterior to posterior direction.
The medial malleolar area is more sensitive than thick posterior skin,
so puncturing the skin in the posterior region is more acceptable for the patient's comfort.
You will find that mines are pretty different.
I will stand on the backside of the patient.
and use a motorized moving table.
Let the patient pose lateral decubitus position facing the wall
and cross the leg posing the medial ankle upside the operation side.
I will block the tibial nerve before other processes.
I don't want to spend time waiting to anesthetize the nerve.
A 5ml is enough to anesthetize the nerve.
I assemble with the 26-gauge 1-inch needle.
I always try to minimize the patient's pain.
Shaking and eliminating air bubbles is an essential step.
When it comes to the block level,
many doctors prefer sites higher than medial malleolus.
He is tracing the tibial nerve from the distal to proximal by sliding.
I noticed that some doctors select the targe above the tarsal tunnel in tarsal tunnel injection.
Multiple insulating layers cover the axons.
The nerve diameter affects the activating time of local anesthetics.
The larger diameter, the more time waiting.
The proximal nerve consists of a single strand and has a large diameter.
The distal nerve consists of multiple smaller branches.
I hate to lose time waiting and save time by selecting smaller branches.
So, I always try to select the target distally.
There are two advantages of the tibial nerve block.
The first one is to prevent procedural pain and make the procedure compatible.
The second benefit is the chronic pain-relieving effect of the local anesthetics.
let me explain the anatomy of the medial ankle.
The tibial nerve split into medial plantar and lateral plantar nerve at the tarsal tunnel.
There is an individual variation of splitting point of medial and lateral plantar nerve.
The medial calcaneal nerve arise from the tibial nerve
Baxter's nerve arises from the lateral plantar nerve
Baxter's nerve is the first branch of the lateral plantar nerve, also known as the inferior calcaneal nerve.
Baxter's nerve branches off 20 mm above the malleolar-calcaneal line.
The medial calcaneal branch originates from the tibial nerve proximal to the bifurcation.
I will insert the needle posterior to the anterior direction under ultrasound guidance.
The needle echo will not be eye-catching
because it is small caliber and disturbing soft tissue echotexture.
I have to focus my attention to find the needle tip.
If I notice the needle tip penetrating the medial septum, it is almost there.
If I push the needle tip without confirming the needle tip, I have to prepare to get a harsh complaint.
The slow and steady fluid injection will infiltrate the interspace connective tissue and anesthetize the four branches.
The gentle massage facilitates the spread of the local anesthetics.
While waiting for the work of the local anesthetics,
I will prepare solutions for the plantar fasciitis injection treatment.
I draw 1.5 ml of 30U botulinum toxin and 0.1ml of 0.35mg of dexamethasone palmitate
let me connect to a 1-inch 26-gauge needle for a venous blood draw.
The next target is the greater saphenous vein.
the vein is located on the superficial fascia of the medial aspect of the tibia
It is a prominent example of a saphenous vein. But, it is not always easy to draw blood under ultrasound.
I will draw 1.5ml of blood from the greater saphenous vein under ultrasound guidance.
the next target is plantar fasciitis. I will change the needle to a 25 gauge 1.5-inch needle.
I have 30U of botulinum toxin, 0.35mg of dexamethasone, and 1.5ml of blood in my syringe.
The frequent secondary infections have been reported in the plantar fasciitis injection,
so I have to be highly cautious and need to clean one more.
I try to relax my hand and not press the piston hard.
I can observe the fluid accumulation in the superficial and deep sides.
Did you notice how much I'm trying to inject with all my heart?
These are the main articles I referred to.
Thank you for watching. See you in the following videos.
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#이미지트레이닝 #만성통증 #통증 #초음파시술 #초음파 #시술 #안전한시술
26 авг 2024
