Join our purpose-driven channel for practical pain management and experience a variety of benefits. Enjoy exclusive access to Master Class and Practical Class memberships designed to help you manage pain effectively.
/ @practicalpainmanageme...
Greetings, Master Class and Practical Class Members!
I'm thrilled to unveil my knee joint injection protocol - the Combo Plus Protocol - tailor-made for addressing severe chronic medial knee pain. Several physicians have expressed curiosity regarding my frequency of using the Combo Plus Protocol and my strategies for patient management post-acute severe pain relief. In response, I'm supplementing this with a medical chart that outlines the patient's treatment journey, protocols, intervals, medications used, and the eventual transition to other alternatives. It becomes the medial knee RPT treatment, interfascial injection with the whole blood. This is because osteoarthritic pain, while not curable, can be managed up to the point of interventions like total knee replacement or even beyond.
For those following my RU-vid channel, the P1 solution and its mixing procedure with Botox should be familiar territory. For details on the quantities and target sites, I delve into it extensively there. I highly recommend viewing the 'Adult Knee Intervention Series,' a comprehensive 15-video sequence if you're unfamiliar.
Now, let's delve into the patient's profile and history.
A 71-year-old female presented with persistent right knee pain lasting for two years. The pain was exacerbated during walking and was particularly pronounced when descending stairs. She reported a clicking sound during movement. She had previously sought treatment from a local pain clinic, receiving a series of injection treatments. Altogether, she underwent injections on ten separate occasions until one week ago.
The patient shared that she had been receiving Prolia injections every three months as a treatment for osteoporosis. Prolia, a monoclonal antibody, is used as an antiosteoporotic agent.
Upon physical examination, she showed pain during passive extension.
An X-ray of the knee indicated minimal degenerative change, less than grade 2 KL degenerative change, with mild loss of the medial joint space. An ultrasound revealed the medial meniscus bulging out, which I categorized as a level 3 bulge based on my ultrasound classification system. Mild suprapatellar bursal effusion was observed, and focal fluid distension was noted in the posterior fossa beneath the posterior capsule
Given her medical history and the persistent pain, I recommended an MRI for a more comprehensive assessment. The MRI results depicted:
A pronounced bone marrow edema in the anterior and medial subchondral bone of the tibia.
Diffuse loss of the hyaline cartilage in the medial femoral condyle accompanied by minimal subchondral bone lesions.
A horizontal degenerative change in the posterior horn of the medial meniscus, along with grade 2 degeneration and a focal tear in the posterior root of the medial meniscus.
Mild fluid in the suprapatellar bursa and localized fluid accumulation in the posterior fossa.
Based on the MRI and ultrasound findings, along with the physical examination, I concluded that the pain's primary origins were:
The subchondral bone marrow lesion in the anterior and middle segments of the medial tibial condyle.
Degenerative changes in the posterior horn of the medial meniscus, combined with a posterior root tear.
A mild, protective, reactive bony spur on the medial side of the knee.
I proposed the "medial knee combo plus" injection protocol for acute pain relief in response to these findings. This regimen encompasses:
A medial interfascial injection containing 30 U of Botox mixed with 0.5 ml of dexamethasone palmitate.
Two blocks on the upper and lower branches of the medial genicular, each containing 0.5 ml of dexamethasone palmitate and 4 ml of bupivacaine.
An injection into the posterior fossa with 1 ml of dexamethasone palmitate and 30U of Botox.
#PracticalPainManagement #spinalintervention #imageguided #learning #koreauniversity #fellowshiptraining # ultrasoundguided #jointinjection#nerveblock #shoulder #safeinjection #asceptic #adhesivecapsulitis #spinalstenosis #rotatorcuff #foraminalstenosis #sacroiliacjoint #kneejoint #anklejoint#imagetrain #GE #Ziehm #MSK #chronicpain #case #lecture #cervical #lumbar #knee #elbow #noninvasive #painfree #ISURA #paindiploma #madi #precise #decisionmaking #limethasone #dexamethasone #palmitate
#이미지트레이닝 #만성통증 #통증 #초음파시술 #초음파 #시술 #안전한시술
26 авг 2024
