WEBVTT

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Vernon Williams. I am the Director of
the Center for Sports Neurology and

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Pain Medicine with the Kerlan-Jobe
Orthopedic Clinic.

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Before treatment, capture a baseline
assessment including a pretreatment

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pain score on a scale of 1 to 10.

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Access mobility by having the
patient rise from a seated position,

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go up and down stairs, or a step stool.

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Palpate the knee to identify
painful areas.

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Document all findings.

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To mark the treatment area for the
anterior femoral cutaneous nerve,

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position the patient in a comfortable
position with the leg extended.

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Next, find and mark the center of
the patella.

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Using a tape measure, measure
from the center of the patella

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to the inguinal crease.

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Calculate one third.

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Starting at the patella, measure the one
third calculation and mark with a dot.

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Next, mark the lateral and
medial poles of the patella.

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Draw a dotted line from the lateral
and medial poles of the patella

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to the one third calculation mark.

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Connect the dotted lines to form
the treatment line.

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To mark the treatment area for the
infrapatellar branch of the

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saphenous nerve, mark the lower
pole of the patella.

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Measure 5 centimeters medial.

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Next, mark the bottom of the tibial
tubercle.

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Measure 5 centimeters medial.

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Connect these 2 dots to form the
treatment line.

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Using a topical anesthetic of choice,
inject local anesthetic superficially

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in the subcutaneous layer using shallow
injections along both treatment lines.

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Press out and massage the
anesthetic into the tissue.

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To begin treating the anterior femoral
cutaneous nerve treatment line,

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insert the Smart Tip and press the
main button to initiate a cooling cycle.

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A tone sounds when the cycle begins.

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Each cycle lasts 65 seconds.

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When the cycle is complete, a check
mark will appear and a tone will sound.

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At the end of the cycle,
remove the smart tip and reposition

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to the next treatment site overlapping
one needle at each insertion site.

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Continue treating the entire
treatment line until completed.

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To begin treating the infrapatellar
saphenous nerve, starting at the top

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and moving down, insert the Smart
Tip and press the main button

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to initiate a cooling cycle.

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A tone sounds when the cycle begins.

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When the cycle is complete, a check
mark will appear and a tone will sound.

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At the end of the cycle, remove the
Smart Tip and reposition to the next

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treatment site, overlapping one
needle at each insertion site.

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Continue treating the entire
treatment line until completed.

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A few things to remember as
you are performing a treatment.

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First, keep the hand piece vertical or
near vertical and no more than 45

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degrees from perpendicular.

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This allows the nitrous oxide to flow
correctly.

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Second, stabilize the skin when
inserting or removing the Smart Tip.

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This helps ensure that the skin warmer
is in full contact with the skin.

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Always remember to hold the hand piece
steady during the treatment cycle,

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minimizing any movement.

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When the treatment is completed, apply
pressure to the treatment line using

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gauze to help reduce bruising.

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Ice may also be applied to help
reduce swelling.

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Then, clean and bandage the area.

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Record the patients' pain scale after
treatment.

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Have the patient perform the same
mobility assessment, whether that is

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rising from a chair or going up and
down stairs or a step stool

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and assess their pain levels now.

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Document all findings.

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Finally, review post-treatment
instructions with the patient.