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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5828_Библиотеки_им_академика_М_И_Перельмана.pdf
224 CHAPTER 10 Lower limb
Muscle injections
Common injection sites involving muscle around the ankle include the plane between the gastrocnemius and soleus.
Medial gastrocnemius
Soleus
Achilles tendon
Lateral gastrocnemius
Calcaneum
10.3.19 Calf tear
10.3 Ankle and foot 225
Patient position: To assess a calf tear (CT), the patient can be
Identifying the anatomy: The CT can be visualised by placing the
Injections performed: Aspiration PRP injections for muscle tears.
Recommended
transducer:
Equipment suggested: Equipment preparation: Set 4 for PRP
Injection technique: Viewing the CT in a SAX orientation, the
positioned in a prone position, with knee fully
extended and the foot hanging over the edge
of the examination couch (Fig. 10.3.19A). If
this position is painful, a rolled towel can
offload the calf and also help stabilise the leg.
transducer in a SAX orientation to identify the
gastrocnemius and soleus muscles. The tear
is usually situated in the plane between both
muscles and can be seen as a hypoechogenic
area (Fig. 10.3.19B and C). Rotating the
transducer into a LAX view enables the full
extent of the tear to be evaluated
(Fig. 10.3.19D and E).
Linear 6e15 mHz.
injections.
Syringe: 10 mL syringe(s) for aspiration.
Needle: 1.5- to 2-inch 21- or 23-gauge
needle.
Standard/available PRP preparation.
needle can be introduced using an IP
technique from the medial or lateral aspect at
an angle of approximately 30e45 degrees
depending on body habitus (Fig. 10.3.19F and
G). With the bevel facing down, the needle
should be brought into the tear and the
haematoma can be aspirated. Once this has
been completed, the syringe can be swapped
to the PRP-containing one and this can be
slowly injected into the space. Alternatively, an
IP LAX approach at 20 e30 degrees can also
be used to deliver this treatment, but more
intact muscle may need to be traversed to
reach the tear and hence there is greater
potential for collateral damage (Fig. 10.3.19H
and I). Offloading and compression post
procedure is important.
226 CHAPTER 10 Lower limb
10.3.19.A
10.3.19.B
Gastrocnemius
CT
Soleus
CT
Soleus
Gastrocnemius
CT
Soleus
CT
Soleus
10.3.19.D
10.3.19.F
10.3.19.H
10.3.19.C
Gastrocnemius
10.3.19.E
10.3.19.G
Gastrocnemius
10.3.19.I
FIGURE 10.3.19 Injections to the CT.
In the prone position the knee is fully extended and foot hangs off the end of the couch.
The injection can be undertaken with the transducer in a LAX or SAX orientation over the
muscle of the foot, and the needle is introduced using an IP technique in either position.
The tear is aspirated, and the PRP can be injected using the same needle.
10.3 Ankle and foot 227
Notes
(Please use this area to reflect on your procedure and how you can build on these
experiences).
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Index
‘Note: Page numbers followed by “f ” indicate figures and “t” indicate tables.’
A
Absolute contraindications, 10
Achilles tendon (AT), 200, 200t, 201f
Acromio-clavicular joint (ACJ), 27, 28f
Adductor tendons (AdT), 135, 135t, 136f
Adhesive capsulitis, 10
Ankle and foot
joints, 184
ligaments, 206
muscles, 224
nerves, 219
tendons, 195
Anterior inferior tibio-fibular ligament (AITFL),
213, 213t, 214f
Anterior talo-fibular ligament (ATFL), 207,
207t, 208f
B
Baker’s cyst (BC), 156, 157f
Biceps femoris tendon (BFT), 163, 163t, 164f
Bleeding, 4
Bruising, 4
Bursa
elbow
distal biceps tendon bursa (DBTB), 67f,
69, 69t
olecranon bursa (OB), 70f, 71, 71t
hip, 141, 141t, 142f
knee
ilio-tibial band bursa (ITB), 175, 175t, 176f
pes anserine bursa (PAB), 173, 173t, 174f
pre-patellar bursa (PPB), 177, 177t, 178f
C
Calcaneo-fibular ligament (CFL), 209, 209t, 210f
Calf tear, 225e227, 225t, 226f
Carpo-metacarpal joint (CMCJ), 83, 83t, 84f
Cervical facet joints (CFJ), 106, 106t, 107f
Cervical nerve roots (CNR), 109, 109t, 110f
Cervical spine, 104f
joints, 105
nerves, 108
Common extensor origin (CEO), 56, 56t, 57f
Common flexor origin (CFO), 58, 58t, 59f
Co-morbidities, 4e5
Consent, 4e5
Consultation, 3
Contraindications, 10e11
Corticosteroid injections (CSIs), 7, 10
D
Deltoid ligament (DL), 211, 211t, 212f
De Quervain’s tenosynovitis (DQT), 88, 88t, 89f
Distal biceps tendon bursa (DBTB), 67f, 69, 69t
Dorsal wrist joint (DWJ), 81, 81t, 82f
Draping, 3e4
E
Elbow, 47f
bursa, 68
joint injection, 48
ligaments, 63, 68f
nerves, 74
posterior fat pad (PFP), 52, 55f
posterior joint line (PJL), 52, 52t, 53f,
55f
tendons, 55, 63f
Equipment, 3, 13, 13te16t
CSI/HA, 13e16
HVI, 13e16
hydrodilatation, 13e16
nerve root/facet joint injections, 13e16
Prolo, 13e16
PRP, 13e16
Extensor carpi ulnaris (ECU), 90, 90t, 91f
F
Flexor hallucis longus (FHL), 202, 202t, 203f
G
Glenohumeral joint (GHJ), 24, 25f
Gluteus medius tendon (GMT), 131, 131t, 132f
H
Hamstring origin (HSO), 137, 137t, 138f
High volume injections (HVIs), 8, 10
Hip, 124f
bursa, 140
hip joint (HJ), 125
muscles, 146
nerves, 143
tendons, 130
Hyaluronic acid (HA) injections, 8, 10
Hydrodilatations, 8, 10
233