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Superior Cluneal Nerve Injection: Difference between revisions
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An ultrasound guided technique for superior cluneal nerve entrapment has been developed, in a cadaveric and live human randomised study.<ref>{{#pmid:31061111}}</ref> | An ultrasound guided technique for superior cluneal nerve entrapment has been developed, in a cadaveric and live human randomised study.<ref>{{#pmid:31061111}}</ref> | ||
*Position: | *Position:Lateral decubitus | ||
*Target: Subfascial layer between the thoracolumbar fascia and erector spinae to ensure injectate spread to all superior cluneal nerves. | *Target: Subfascial layer between the thoracolumbar fascia and erector spinae to ensure injectate spread to all superior cluneal nerves. | ||
*Probe:High frequency linear transducer. | *Probe:High frequency linear transducer. | ||
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*Insert needle lateral to medial, pierce the thoracolumbar fascia just medial to the point of fusion with the anterior layer at the lateral margin of the erector spinae. | *Insert needle lateral to medial, pierce the thoracolumbar fascia just medial to the point of fusion with the anterior layer at the lateral margin of the erector spinae. | ||
*The erector spinae muscle and posterior layer of the thoracolumbar fascia should separate during injection, and as this happens move the needle medially. | *The erector spinae muscle and posterior layer of the thoracolumbar fascia should separate during injection, and as this happens move the needle medially. | ||
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===Fluoroscopy Guided=== | ===Fluoroscopy Guided=== |
Revision as of 06:30, 16 September 2020
This article is a stub.
Superior Cluneal Nerve Injection | |
---|---|
Indication | Cluneal nerve pain |
Syringe | 10mL |
Needle | 80mm nerve block needle |
Steroid | optional |
Local | doctor choice |
Volume | ?10-15mL |
Anatomy
Indications
Contraindications
Pre-procedural Evaluation
Equipment
Technique
Injection can be done by landmark guided palpation based on the maximal area of tenderness, and/or by ultrasound guidance. Injections are typically done with local anaesthetic, but dextrose prolotherapy can be used[1]
Ultrasound Guided
- SCN Injection
An ultrasound guided technique for superior cluneal nerve entrapment has been developed, in a cadaveric and live human randomised study.[2]
- Position:Lateral decubitus
- Target: Subfascial layer between the thoracolumbar fascia and erector spinae to ensure injectate spread to all superior cluneal nerves.
- Probe:High frequency linear transducer.
- Identify the lateral border of the erector spinae muscle at the level of the superior margin of the iliac crest, which fuses laterally with the transverse abdominis aponeurosis.
- Trace the erector spinae caudally to the level of the iliac crest
- Keep the transducer cranial to the level of where the lumbar intermuscular aponeurosis fuses with the posterior layer of the thoracolumbar fascia.
- Insert needle lateral to medial, pierce the thoracolumbar fascia just medial to the point of fusion with the anterior layer at the lateral margin of the erector spinae.
- The erector spinae muscle and posterior layer of the thoracolumbar fascia should separate during injection, and as this happens move the needle medially.
Fluoroscopy Guided
Landmark Guided
- SCN Injection
- Position: Prone
- Palpate: posterior wings of the iliac crest, 6-7cm lateral from the midline, and mark the area. Often there is a small lipoma, and use this to guide needle placement around the lipoma.
- Advance needle perpendicularly to the marked area under contact with bone.
- Following negative aspiration inject 1mL of solution