Continuous Sciatic Nerve Block

Best Stretches for Sciatica

Hello I'm Heather Moore owner ofTotal Performance Physical Therapy. Today we're going to go over the best exercisesfor sciatica. There's really one main stretch that you can do a bunch of different waysif you're getting numbness and tingling down your leg, if you'r e getting pain throughyour back, in your butt you should do this stretch multiple times throughout the day,when you do it you want to try and hold it for about 30 seconds, you want to try andperform 6 repetitions if you can't do it for that long that's okay hold it for as longas you can, if for any reason these are going to increase your pain you need to stop immediatelyand call your but this should alleviate

a lot of your body pain specially if you aresitting for a long period of time or you get a lot of pain down your leg. The first oneis in the seated position you want to sit up nice and straight, you want to cross yourankle over your knee if you feel a stretch there that's where you need to stop, if youdon't feel a stretch there all you wann do is sit up and lean forward and you shouldfeel a greater stretch through your butt, through your hamstring which is in the backof your leg and through the side of your leg, you may even feel a little bit on your backdepending on where your tight is again this shouldn't hurt and should feel like a goodstretch, you could do this sitting at your

desk all day long, you also want to make surethat you concentrate on both sides not just the side that hurts, piriformis muscle whichis what this is stretching on both sides and will tag evenly on your sacrum or your tailbone so you want to make sure that you do both sides and not just one. The next wayto do this stretch is standing up, you want to find a surface where you can put your leg,your hip at about 90 degrees and you're going to bring your foot up and you're just goingto have it lay on the table and you're going to let your knee drop to the side, if yourknee doesn't fall all the way down that's okay, don't force it down let it just staythere again if you get, if you're in this

position and you don;t feel a stretch youcan now begin to lean forward, you're going to feel the stretch in your back, in yourglut, in your hamstring and all the side of your leg, this should not be painful it shouldfeel like a nice stretch this one also you want to do 30 seconds hold about 6 repetitionsand you want to make sure that you hit both sides. The final way to do this stretch islaying down, so you want to lay on your back and this is a good thing to do when you getup in the morning, go ahead and bend both your knees up and then you're going to crossyour ankle over your knee, now again if this is where you feel a stretch stop right thereand hold it, if you don't feel a stretch in

this position you're going to reach both armsbehind this leg and you're going to pull it up towards your chest, you should feel a stretchagain in the back, in the glut, in the hamstring or maybe even on the side of the leg, it shouldnot hurt it should feel like a nice gentle stretch, you want to hold this about 30 secondsand you want to do about 6 of those you can do this as many times during the day as youwould like there is no set number or times that you can do this, anytime your tight youcan do this and it will not harm you.

Cadaver Surface and Ultrasound Guided Anatomy of Nerve Blocks in Anesthesia Program

We'll be talking about the interscaleneblock. The analgesia of the brachial plexus, which enervates the arms, is an example ofa major nerve block. That is because two or more nerves are blocked that supply a largearea. Types of surgeries that would benefit from interscalene block include the shoulder,arm, and forearm procedures. Injection at the interscalene level will block dermatomesC5 through C7 intensely, and dermatomes C8 through T1 less intensely. The interscalene groove lies at the cricoidcartilage, the level of the cricoid cartilage. It's important to find the sternal notchand trace it over to the clavicle, and then

outline the sternocleidomastoid muscle. Itis recommended that you also outline your carotid artery, internal jugular, and external jugular vein.You will also see the anterior scalene muscle, little scalene muscle, and the nerve rootsof C5 through C7. There are several maneuvers that can accentuate the line marks while thepatient is lying supine. First you have the patient turn their head to the contralateralside. This is when you will be able to see the external jugular vein cross the interscalenegroove at the level of the cricoid cartilage. This also tenses the sternocleidomastoid muscle.You may also ask the patient to reach to the

ipsilateral knee. This maneuver flattens theneck and makes the identification of the scalene muscles easier. Some complications that occurinclude incidental block of the phrenic nerve, recurrent laryngeal nerve, and stellate gangliondue to close proximity. Dyspnea may occur from the nerve, the phrenic nerve, causing hoarseness, andfrom the recurrent laryngeal nerve. Since the area is very vascular, there ispotential for inadvertent intravascular injection. First, this is the clavicle. Here is the sternocleidomastoid muscle. Common carotid.

Internal jugular. External jugular. Anterior scalene muscle. And middle scalenemuscle. And the three trunks for the brachial plexus: superior, middle, inferior. This is the left arm, and the branches ofthe brachial plexus are the musculocutaneous nerve, the median nerve, the ulnar nerve, the radial nerve, and the axillary nerve.

Here we have an ultrasound view of the interscaleneblock. We are looking at the right side of the neck. This is medial, and this side of the ultrasound is lateral. We have the carotid artery here, we have the right IJ here, andShane's doing a Valsalva maneuver right now. We have the anterior scalene muscle here,the middle scalene muscle here, and our sternocleidomastoid on top. The nerve bundle is located betweenthe anterior scalene muscle and the middle scalene muscle here, and here's our nervebundle, right in there. Here we have the surface anatomy for a femoralblock. First you want to identify the anterior superior iliac spine and the pubic tubercle,and draw a line connecting these structures.

This is the inguinal ligament. Midline on the inguinal ligament, you'll palpate to find the femoral pulse. And using your VAN acronym, you can see the femoralvein, femoral artery, and femoral nerve. To find the femoral nerve from the femoral pulse,you'll go two centimeters distal and two centimeters lateral. I will use the width of my finger to approximate this distance. Two centimeters distal, two centimeters lateral, and you will end up right over the femoral nerve. This is your injection point. Here we have a cadaver dissection of our upperthigh area, where we will be performing our

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