FIGURE 8.12 Right thigh and femoral triangle structures. (From Tank PW, Gest TR. Lippincott Williams & Wilkins Atlas of Anatomy. Philadelphia, PA: Lippincott Williams & Wilkins, 2009.)
PATIENT POSITION
- Lying supine on the examination table.
- Place the hip in a position of combined flexion abduction and external rotation.
- Rotate the patient’s head away from the side that is being injected. This minimizes anxiety and pain perception.
LANDMARKS
1. With the patient lying supine on the examination table, the clinician stands lateral and posterior to the affected hip.
2. Locate the symphysis pubis and trace the pubic bone laterally until the origin of the hip adductor muscles.
3. Determine the site of maximal tenderness over the tendons, and mark it with an ink pen.
4. At that site, press firmly on the skin with the retracted tip of a ballpoint pen. This indention represents the entry point for the needle.
5. After the landmarks are identified, the patient should not move the hip.
ANESTHESIA
- Local anesthesia of the skin using a topical vapocoolant spray
EQUIPMENT
- 3-mL syringe
- 25-gauge, 1½ in. needle
- 1 mL of 1% lidocaine without epinephrine
- 1 mL of the steroid solution (40 mg of triamcinolone acetonide)
- One alcohol prep pad
- Two povidone–iodine prep pads
- Sterile gauze pads
- Sterile adhesive bandage
TECHNIQUE
1. Prep the insertion site with alcohol followed by the povidone–iodine pads.
2. Achieve good local anesthesia by using a topical vapocoolant spray.
3. Position the needle and syringe at an angle of 30 degrees to the skin with the tip of the needle directed proximally toward the pubic bone.
4. Using the no-touch technique, introduce the needle at the insertion site (Fig. 8.13).
5. Advance the needle so that it is positioned around the affected tendon, but not in the substance of the tendon.
6. Inject the steroid solution as a bolus around the adductor tendon(s). The injected solution should flow smoothly into the space. If increased resistance is encountered, advance or withdraw the needle slightly before attempting further injection.
7. Following injection of the corticosteroid solution, withdraw the needle.
8. Apply a sterile adhesive bandage.
9. Instruct the patient to massage the area and move his or her hip through its full range of motion. This movement distributes the steroid solution along the adductor tendon(s).
10. Reexamine the medial aspect of the hip in 5 min to confirm pain relief.
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