michael c. phillips lipid retired 2013 Cohen (lawyer) michael c. phillips retired 2013

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Technique Ultrasound-guided approach (preferred) Local Corticosteroid Injection at tendon sheath under Ultrasound guidance (see Shoulder Ultrasound) Approached in-plane to linear Ultrasound probe (probe short axis to anterior Shoulder - home position) Do not inject within tendon (and avoid circumflex artery within groove) Technique Landmark-based approach Images Landmarks Identify bicipital tendon in bicipital groove (proximal Humerus) Mark point of maximal tenderness over groove Injected with sterile technique (with Betadine preparation of skin) Direct needle parallel to bicipital groove (vertically oriented) Needle enters skin at 30 degrees oriented superiorly Do not inject bicipital tendon Infiltrate area around groove, but not into tendon Flow resisted when needle is inside tendon Withdraw needle slightly and retry Continue to withdraw until not in tendon Complications Bicipital tendon rupture Associated with intratendinous injection Do not inject bicipital tendon References

10.1136/gutjnl-2020-322129 [DOI] [PMC free article] [PubMed] [Google Scholar] 29

doi: 10.1016/j.cryobiol.2023.03.003 91 BriardJGPoissonJSTurnerTRCapicciottiCJAckerJPBenRN

Staying well-hydrated by drinking plenty of water can help your body flush out the broken-down fat cells more efficiently

SUPPORTS CIRCULATION: Grape Seed acts as a vasodilator, helping to open blood vessels and relax the muscles of the circulatory system for easy blood flow, enabling efficient nutrient and oxygen delivery as well as lessening capillary pressure, which is the main cause of bleeding from the lungs in performance horses