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Consent ✅ Weight trainer Diffuse achy lateral elbow pain (through supinator region), vague symptoms radiating into forearm and dorsum thumb webspace worse on pronation - supination under load Tender ++ palpation through supinator & PIN Radial tunnel / supinator syndrome POCUS video - US guided hydrodissection of PIN just... show more

James Noake

34,193 subscribers

16,887 Aufrufe • vor 2 Jahren •via X (Twitter)

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8 Kommentare

Profilbild von Zach Bailowitz MD, RMSK

Zach Bailowitz MD, RMSKvor 2 Jahren

I love this injection. So often patients have been told they have tennis elbow yet no treatments have helped. And suddenly they see major changes with treating the PIN 💪

Profilbild von Christopher McMullen

Christopher McMullenvor 2 Jahren

Thanks for sharing; appreciate your videos. PIN is a motor nerve - what’s the theory behind this providing pain relief, particularly to the radiating forearm symptoms?

Profilbild von Derek Petit

Derek Petitvor 2 Jahren

Do you aim a bit more distal sometimes? I’ve had pretty good success targeting in-between the 2 heads of supinator

Profilbild von James Noake

James Noakevor 2 Jahren

Yep depends where Tinels is sore, nerve swelling etc

Profilbild von Louise Duncan

Louise Duncanvor 2 Jahren

Very satisfying to watch never mind carry out - thanks for sharing 🙏🏻

Profilbild von No SuperDoc

No SuperDocvor 2 Jahren

Do you inject some CS or only saline ?

Profilbild von James Noake

James Noakevor 2 Jahren

D5 and CSI

Profilbild von Dawn Bradley

Dawn Bradleyvor 2 Jahren

How was response to treatment?

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We've created animation on the same topic, but this time with a close-up view and a layer-by-layer breakdown. This animation highlights the action of the Pronator Teres and Supinator muscles as they work to rotate the radius, enabling pronation and supination of the forearm.

We've created animation on the same topic, but this time with a close-up view and a layer-by-layer breakdown. This animation highlights the action of the Pronator Teres and Supinator muscles as they work to rotate the radius, enabling pronation and supination of the forearm.

Anatomy Standard

128,406 Aufrufe • vor 1 Jahr

Consent ✅ Middla aged Ironman Months of L inferior gluteal pain that radiates into posterior thigh to knee - burning / throbbing Recent 'pop' in gluteal region with sudden hip & lumbar flexion Worse on - running / fast walking, sitting, cough / sneeze +ive proximal hamstring tendinopathy tests +ive adductor magnus bias tests +ive SLR neural tension Pain LSp flexion, limited POCUS & MRI - interface tear (peel away lesion) of proximal hamstring but remaining tendons intact, so no retraction LSp MRI - L sided disc bulge irritating L S1 nerve root So - concurrent pain drivers? Or one injury mimicking the other? PHT pain can refer pain distally into hamstring. What next after 3 months rehab / load mods & no change? 🧐 Patient will return with symptoms provoked - then US guided LA only injection to proximal hamstring tendon - then re-test - easier & safer to rule out / in tendon driven symptoms first before considering spinal options.

Consent ✅ Middla aged Ironman Months of L inferior gluteal pain that radiates into posterior thigh to knee - burning / throbbing Recent 'pop' in gluteal region with sudden hip & lumbar flexion Worse on - running / fast walking, sitting, cough / sneeze +ive proximal hamstring tendinopathy tests +ive adductor magnus bias tests +ive SLR neural tension Pain LSp flexion, limited POCUS & MRI - interface tear (peel away lesion) of proximal hamstring but remaining tendons intact, so no retraction LSp MRI - L sided disc bulge irritating L S1 nerve root So - concurrent pain drivers? Or one injury mimicking the other? PHT pain can refer pain distally into hamstring. What next after 3 months rehab / load mods & no change? 🧐 Patient will return with symptoms provoked - then US guided LA only injection to proximal hamstring tendon - then re-test - easier & safer to rule out / in tendon driven symptoms first before considering spinal options.

James Noake

19,433 Aufrufe • vor 1 Jahr

Do these exercises to protect your UCL 👇⁠ ⁠ ✅ Fingertip holds / bar hangs – build the flexor strength that takes stress off the ligament⁠ ✅ Band pronation – train control through full supination⁠ ✅ Band deviation – strengthen the forearm through thumb-up / thumb-down motion⁠ ✅ Isometric bat/dowel holds – stability in end-range positions⁠ ✅ Offset barbell holds – target the FCU to stabilize the inner elbow

Do these exercises to protect your UCL 👇⁠ ⁠ ✅ Fingertip holds / bar hangs – build the flexor strength that takes stress off the ligament⁠ ✅ Band pronation – train control through full supination⁠ ✅ Band deviation – strengthen the forearm through thumb-up / thumb-down motion⁠ ✅ Isometric bat/dowel holds – stability in end-range positions⁠ ✅ Offset barbell holds – target the FCU to stabilize the inner elbow

Tread Athletics

18,351 Aufrufe • vor 3 Monaten

Consent ✅ Female early 20s - overweight Started running for weight loss Bilateral cramps medial gaiter area & ankle pain Complains of 'swelling' in the region Pain settles quickly post exercise after 30-60mins More recently P&N spreading into plantar aspect of foot Video slide show - MRI shows hypertrophied FHL muscle belly & very low lying, down to level of sub-talar joint Now causing tarsal tunnel symptoms - tibial nerve (with high signal / mild oedema) immediately adjacent to FHL muscle belly Low lying / accessory soleus can also behave like this Consider gait re-training, optimising triceps surae capacity to 'offset' FHL, botox, US guided targeted tarsal tunnel hydrodissection injection, de-bulking of muscle as last resort if conservative measures fail

Consent ✅ Female early 20s - overweight Started running for weight loss Bilateral cramps medial gaiter area & ankle pain Complains of 'swelling' in the region Pain settles quickly post exercise after 30-60mins More recently P&N spreading into plantar aspect of foot Video slide show - MRI shows hypertrophied FHL muscle belly & very low lying, down to level of sub-talar joint Now causing tarsal tunnel symptoms - tibial nerve (with high signal / mild oedema) immediately adjacent to FHL muscle belly Low lying / accessory soleus can also behave like this Consider gait re-training, optimising triceps surae capacity to 'offset' FHL, botox, US guided targeted tarsal tunnel hydrodissection injection, de-bulking of muscle as last resort if conservative measures fail

James Noake

12,853 Aufrufe • vor 1 Jahr

Consent✅ Another - possible - genicular nerve case Runner, bilateral lateral knee pain Treated as ITB overload; exhausted all non-surgical options so reasonably proceeded to targeted partial ITB release Unfortunately symptoms persisted but changed in nature - 'burning' now (L more than R), slightly more diffuse & symptoms with sitting, not just on exercise POCUS video - Scarred thickened ITB (typical post-surgical legacy) seen, with superolateral genicular NV bundle sat just deep to it Injection - hydrodissection of scar tissue around the NV bundle, freeing up the fascial plane systematically - hard work because of the density of the tissue Post procedure (volume up) - patient essentially pain free on the treadmill - R side (not injected) still painful

Consent✅ Another - possible - genicular nerve case Runner, bilateral lateral knee pain Treated as ITB overload; exhausted all non-surgical options so reasonably proceeded to targeted partial ITB release Unfortunately symptoms persisted but changed in nature - 'burning' now (L more than R), slightly more diffuse & symptoms with sitting, not just on exercise POCUS video - Scarred thickened ITB (typical post-surgical legacy) seen, with superolateral genicular NV bundle sat just deep to it Injection - hydrodissection of scar tissue around the NV bundle, freeing up the fascial plane systematically - hard work because of the density of the tissue Post procedure (volume up) - patient essentially pain free on the treadmill - R side (not injected) still painful

James Noake

19,381 Aufrufe • vor 6 Monaten

Radio 4’s landmark series Child launches into birth✨ This week India Rakusen leads us on a journey through some of the key areas of birth from consent and trust through to pain and the ‘golden hour’. Child | Listen on BBC Sounds

Radio 4’s landmark series Child launches into birth✨ This week India Rakusen leads us on a journey through some of the key areas of birth from consent and trust through to pain and the ‘golden hour’. Child | Listen on BBC Sounds

BBC Radio 4

15,820 Aufrufe • vor 2 Jahren

Consent ✅ Retired nurse, 60s Decade of flank / loin pain - perceived around thoracolumbar junction (blue cross) Extensive MSK, renal and GI investigations - no diagnosis forthcoming CT and MRI of spine reported normal On systematic palpation / PA glide in prone, her pain is actually provoked more inferiorly (green cross) POCUS video - calcific changes at 12 rib interface with spine, correlating with her pain - there is no true costotransverse joint at this level, rather ligamentous attachments- so this represents an enthesopathy / 'ligamentopathy' US guided LA & CSI - complete abolition of pain after 10 years! (see enthusiastic gyrating - sound on)

Consent ✅ Retired nurse, 60s Decade of flank / loin pain - perceived around thoracolumbar junction (blue cross) Extensive MSK, renal and GI investigations - no diagnosis forthcoming CT and MRI of spine reported normal On systematic palpation / PA glide in prone, her pain is actually provoked more inferiorly (green cross) POCUS video - calcific changes at 12 rib interface with spine, correlating with her pain - there is no true costotransverse joint at this level, rather ligamentous attachments- so this represents an enthesopathy / 'ligamentopathy' US guided LA & CSI - complete abolition of pain after 10 years! (see enthusiastic gyrating - sound on)

James Noake

50,229 Aufrufe • vor 2 Monaten

Consent✅ Runner, HIIT Deep left buttock pain Occasionally travels down posterior thigh with intermittent parasthesia & numbness lower leg & foot Brought on with pigeon stretching, yoga, as well 4 point kneeling core hip extension / adduction work 🤷‍♂️ Sitting main aggravating factor - isometric single leg bridging as well Clinical exam difficult to reproduce pain but discomfort on palpation through deep gluteal space MRI: Lumbar spine - normal Pelvis - mildly reduced ischiofemoral interval L side - subtle oedema in quadratus femoris (QF) POCUS video: With passive hip external rotation (closing down the ischiofemoral space) can see bunching of QF and tenting of sciatic nerve (SN) - 'Eruption Sign' - maintaining probe pressure on this soft tissue during the manoeuvre reproduces typical pain US guided injection (lateral to medial to avoid SN) to QF and ischiofemoral space - immediate reduction in sitting pain post procedure

Consent✅ Runner, HIIT Deep left buttock pain Occasionally travels down posterior thigh with intermittent parasthesia & numbness lower leg & foot Brought on with pigeon stretching, yoga, as well 4 point kneeling core hip extension / adduction work 🤷‍♂️ Sitting main aggravating factor - isometric single leg bridging as well Clinical exam difficult to reproduce pain but discomfort on palpation through deep gluteal space MRI: Lumbar spine - normal Pelvis - mildly reduced ischiofemoral interval L side - subtle oedema in quadratus femoris (QF) POCUS video: With passive hip external rotation (closing down the ischiofemoral space) can see bunching of QF and tenting of sciatic nerve (SN) - 'Eruption Sign' - maintaining probe pressure on this soft tissue during the manoeuvre reproduces typical pain US guided injection (lateral to medial to avoid SN) to QF and ischiofemoral space - immediate reduction in sitting pain post procedure

James Noake

16,304 Aufrufe • vor 5 Monaten

Consent ✅ Footballer - ACL recon & MCL tear 12 months ago Uneventful rehab process & RTP ...... but then developed focal pain over medial joint line & restricted flexion Sore on side passing & cutting / change of direction drills OE - Palpation pain at proximal MCL Stiff & painful into EROM flexion MRI - no medial pathology reported - but on closer inspection, subtle medium signal focal change in deep MCL on T1 & T2 (always check the scan yourself) POCUS - obvious large heterotopic calcific deposit in previously injured proximal MCL fibres - Pelligrini-Stieda lesion Video - needle barbotage / fenestration of deposit, finished with a soupçon of CSI 🫰 Post procedure, complete abolition of pain in gym & typical provocative movements ✅ Ultrasound is much better than MRI in identifying calcific pathology (as is plain x-ray)

Consent ✅ Footballer - ACL recon & MCL tear 12 months ago Uneventful rehab process & RTP ...... but then developed focal pain over medial joint line & restricted flexion Sore on side passing & cutting / change of direction drills OE - Palpation pain at proximal MCL Stiff & painful into EROM flexion MRI - no medial pathology reported - but on closer inspection, subtle medium signal focal change in deep MCL on T1 & T2 (always check the scan yourself) POCUS - obvious large heterotopic calcific deposit in previously injured proximal MCL fibres - Pelligrini-Stieda lesion Video - needle barbotage / fenestration of deposit, finished with a soupçon of CSI 🫰 Post procedure, complete abolition of pain in gym & typical provocative movements ✅ Ultrasound is much better than MRI in identifying calcific pathology (as is plain x-ray)

James Noake

20,150 Aufrufe • vor 8 Monaten

Pronation & Supination of the Foot & Ankle Learn more:

Pronation & Supination of the Foot & Ankle Learn more:

E3Rehab

32,448 Aufrufe • vor 1 Jahr

Consent✅ ACL reconstuction with lateral tenodesis 9 months ago Persistent lateral pain 'sliding / catching' sensation over tenodesis site on predictable knee flexion squat angle Tenodesis screw looks ok on x-ray POCUS - fluid / inflammation seen around graft as passes under LCL (graft = circle.... then narrow slip as US turns longitudinal) @orthotwitter - do you see graft / tenodesis soft tissue irritation - impingement? - in any of your cases?

Consent✅ ACL reconstuction with lateral tenodesis 9 months ago Persistent lateral pain 'sliding / catching' sensation over tenodesis site on predictable knee flexion squat angle Tenodesis screw looks ok on x-ray POCUS - fluid / inflammation seen around graft as passes under LCL (graft = circle.... then narrow slip as US turns longitudinal) @orthotwitter - do you see graft / tenodesis soft tissue irritation - impingement? - in any of your cases?

James Noake

25,782 Aufrufe • vor 2 Jahren

Lifetime PR of 96.1 MPH (94.4 avg) for LAA MiLBer and Tread Athlete Hayden Seig Not bad for the high slot supinator heading into ST who averaged around 92 MPH the last two years Played in A, A+, AA, and AAA in ‘23 Hayden Seig Leif Strom Tread Athletics Metrics table below ⬇️

Lifetime PR of 96.1 MPH (94.4 avg) for LAA MiLBer and Tread Athlete Hayden Seig Not bad for the high slot supinator heading into ST who averaged around 92 MPH the last two years Played in A, A+, AA, and AAA in ‘23 Hayden Seig Leif Strom Tread Athletics Metrics table below ⬇️

Rylan Domingues

15,262 Aufrufe • vor 2 Jahren

Compiled a bunch of my Arknights animations into one video, just so I can pin it

Compiled a bunch of my Arknights animations into one video, just so I can pin it

dann

36,213 Aufrufe • vor 5 Monaten

Recent case of ESD of squamous cell carcinoma of the mid-esophagus Distal incision --> proximal incision --> submucosal tunnel to connect the two --> lateral incision and submucosal dissection Curative resection with negative deep/lateral margins [posted with permission]

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Ahmad Bazarbashi MD أحمد بازارباشي

16,661 Aufrufe • vor 2 Jahren

Consent✅ Female, 20s L upper abdominal pain since lockdown - on back of increased home work outs including ab & core work Now pain lying supine, prone, trunk rotation, being hugged, deep inspiration.... Hugely impactful on QoL Seen multiple specialists - GI, gynae (!), respiratory - utterly frustrated Referred as possible ACNE syndrome - but not in the right place anatomically (ACNE is peri-umbilical semilunaris border) OE - hypermobile ? EDS Focal pain on gentle palpation into immediate L inferior costal margin EROM thoracic rotation painful, plus trunk flexion / extension POCUS video - L 'floating rib' - possibly 11th - seen subluxed superficially over adjacent rib, vs normal side sat 'flush' On deep inspiration, pain reproduced with probe pressure maintained as irritable over-lying soft tissue 'tents' Diagnosis - 'Floating rib' or 'rib tip' syndrome Outcome - symptoms validated - no more medical 'rabbit holes' - surgical resection

Consent✅ Female, 20s L upper abdominal pain since lockdown - on back of increased home work outs including ab & core work Now pain lying supine, prone, trunk rotation, being hugged, deep inspiration.... Hugely impactful on QoL Seen multiple specialists - GI, gynae (!), respiratory - utterly frustrated Referred as possible ACNE syndrome - but not in the right place anatomically (ACNE is peri-umbilical semilunaris border) OE - hypermobile ? EDS Focal pain on gentle palpation into immediate L inferior costal margin EROM thoracic rotation painful, plus trunk flexion / extension POCUS video - L 'floating rib' - possibly 11th - seen subluxed superficially over adjacent rib, vs normal side sat 'flush' On deep inspiration, pain reproduced with probe pressure maintained as irritable over-lying soft tissue 'tents' Diagnosis - 'Floating rib' or 'rib tip' syndrome Outcome - symptoms validated - no more medical 'rabbit holes' - surgical resection

James Noake

24,669 Aufrufe • vor 6 Monaten

Consent✅ Hip osteoarthritis can be readily seen on POCUS Use internal and external rotation to view a surprisingly wide area of femoral head cartilage

Consent✅ Hip osteoarthritis can be readily seen on POCUS Use internal and external rotation to view a surprisingly wide area of femoral head cartilage

James Noake

12,141 Aufrufe • vor 4 Monaten

The beauty and pain of the Old Course at St. Andrews! Watching some elite amateurs come through 18. Amazing how flummoxed these guys are getting. Unwilling to just be 20 feet past the hole, they go for the pin. 30 yard pitches proving devilish! My favorite place on earth.

The beauty and pain of the Old Course at St. Andrews! Watching some elite amateurs come through 18. Amazing how flummoxed these guys are getting. Unwilling to just be 20 feet past the hole, they go for the pin. 30 yard pitches proving devilish! My favorite place on earth.

Rick Golfs

167,776 Aufrufe • vor 29 Tagen

Delta Flight Attendants: Join thousands of us at to petition Delta to retract their pin policy change and implement policies that actually protect us from harassment. This is not just about a pin or a picture—it’s about defending our dignity.

Delta Flight Attendants: Join thousands of us at to petition Delta to retract their pin policy change and implement policies that actually protect us from harassment. This is not just about a pin or a picture—it’s about defending our dignity.

DeltaAFA

116,443 Aufrufe • vor 2 Jahren

"I know he's looking down and helped ride that horse down through the wire." Following INCREDIBOLT's Virginia Derby win and 50 Derby points earned, trainer Riley Mott discussed the loss of Pin Oak Stud's Jim Bernhard with Scott Hazelton.

"I know he's looking down and helped ride that horse down through the wire." Following INCREDIBOLT's Virginia Derby win and 50 Derby points earned, trainer Riley Mott discussed the loss of Pin Oak Stud's Jim Bernhard with Scott Hazelton.

FanDuel Racing

20,318 Aufrufe • vor 3 Monaten