I'll use the right leg for our example, as illustrated in the picture [on page 48]. The patient is supine, with the right leg in the same 90-90 position I described above. I am sitting on the patient's right side, with my right shoulder against their posterior thigh. I use both of my hands to grasp firmly around the whole of the upper thigh. My left hand will be the main hand, with the heel of my left hand pushing against the greater trochanter. I pre-tension the area by both lifting the whole thigh superior and taking it into internal rotation to the feather edge of the barrier. I then do a quick thrust into further internal rotation. I really don't use much fine-tuning of three dimensions here; it's a pure thrust into internal rotation.
In patients in whom there is a suspicion of infection within the joint, steroid injections should be avoided. As steroids can alter blood sugar levels, they should be used with caution in patients who have poorly controlled diabetes. They should also be used with caution in patients who are on blood thinning medication such as Aspirin or Warfarin. Patients are usually requested to stop blood thinning medication for a few days before the procedure. Any known allergy to the components of the steroid injections is also an indication to avoid administering it.
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