Can you light that up a bit on the bottom? Yeah. Perfect. And that's one more depth. Okay, so we're going to keep moving caudate and down to the knee. I know some of you have already started the knee. So we're going to do the knee injection here. I'm just going to go over the standard super patellar injection. And so we're long axis on the knee joint. So to the right of the screen is distal, and we see the bony contour of the patella. To the left of the screen is proximal, so we're on the quadricep tendon. And right below the quadricep tendon, we see that hyperechoic triangle. That triangle is the super patellar fat pad. Below that, we see that is next to the cortex of the femur, we see the pre-femoral fat. And so we see a nice demarcation between the pre-femoral fat and the super patellar fat pad, that triangle, which is the inter-articular space. And what I'm going to do is just squeeze medial and laterally, compress, and now you can just confirm that that is the inter-articular space. So now this gets a lot easier. You know exactly where you're going. All right, so I go short axis to this. And so to the left is lateral, to the right is medial. And I'm not going to squeeze you, I'm not going to compress. And so if I very gently move back and forth, well, I'm going to get fluid here. You can see that demarcation between the pre-femoral fat and the super patellar fat pad. So there it is. So this becomes an easier injection now when we see the fluid. And to be honest, most people that have osteoarthritis are going to have a small amount of fluid or you're going to see a very thick super patellar synovial recess and it's going to get easier. And so I can go over the injection. You're pretty aware of, it's getting slippery, aware of what to do. But I tend to go down a little more posterior. So I'm not going to see the needle right away necessarily. So I'm going to just translate back over and there we go. And I'm going to follow my track of the needle down and get into that space. And I can confirm it and there we are. And then I would inject. So that's how I do my knee injection. I like to see it flow inter-articularly. So I'm 100% sure. So I stay away from bone. It's why I do my subacromial injections more anteriorly. So I'm not under the acromion and I can actually see the bursa distend and go both proximally and distally. So the same with the knee. I just like to see the injectate flow inter-articularly. Okay. Oh. Yeah. So patellar tendon. All right. So patellar tendon is, so here we see patellar tendon on short axis. We're going to go cephalad and now we're on patella. There's actually a continuation of the quadricep and patellar tendon. And now we're going to go distally into the tibial tubercle. So when I do my knee injection, I'm going to go distally into the tibial tubercle. I'm going to go distally into the tibial tubercle. I often will go short axis and I tend to go lateral to medial. And the reason why is because often what we see with patellar tendinopathy is we see the central part of the tendon have the tendinopathic tissue. So it's a partial tear, it's hypoechoic, it's vascular, and even a right along a deep aspect of the patellar itself. And so I've just, because this is the way I do 10X and I've just found the injections are quite easy and I can toggle back between long and short axis to know where I am as far as the cephalic-cod-dad portion of the tendon. But I like to do my injections in a short axis fashion. Let's see where the probe is here. And you're going pretty superficial here. So I typically would want a smaller needle for this, let's see. There we go. So, what I would typically do is come in just a little bit more posterior here. There we go, and I would go right down and right into that central area of the tendon, and I would often fenestrate and then inject. Now, you can go long axis and some people do that, but a lot of us that are doing 10X procedures are doing them in the short axis of the patellar tendon and we've been pretty happy with that. So, if I go long axis here, again, you can get a perspective of where that needle is. So, proximal is to the right and I'm actually pretty distal in the tendon there. So, you can use this perspective to go toggle back and forth and know where you are. So, if you want to be proximal, then you know what you need to do. If you want to be distal, then you know what you need to do. So, then again, I can take the needle and go more proximally. So, again, I toggle back and forth between the two. Okay. For those, I need a thinner needle.

knee injection

super patellar fat pad

inter-articular space

injectate flow

thinner needle