◔
Superior Cluneal Nerve Injection
From WikiMSK
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
An ultrasound guided technique has been developed, in a cadaveric and live human randomised study.[2]
- Position:Laterla 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.