The patient is placed in the prone position and fluoroscopy is used to identify bony structures of the pelvis on the affected side. The beam is centered on the obturator foramen and the target area for injection is the inferior aspect of the ischial tuberosity (Figure 5a and 5b). A inch 22 gauge spinal needle is advanced under fluoroscopic guidance to the point of contact with the ischial tuberosity. The patient is asked to extend their hip or flex their knee to determine if the needle moves with contraction. If the needle is determined to be within musculotendinous structure, then repositioning of the needle is required. After negative aspiration, a small amount of radio opaque contrast is injected to confirm spread along the ischial bursa. Once bursogram image is obtained inject mixture of local anesthetic and/or steroid. The therapeutic medication, which includes local anesthetic (2-3 cc of either 1% lidocaine or bupivacaine %) and steroid (betamethasone (6mg/ml) or triamcinolone (40mg/ml)) is then injected with a total volume of 3 to 4 cc.
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