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The inhibition of LOX-mediated cross-linking of type I and III collagen fibers leads to decreased toughness and elasticity of connective tissue

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Special items and suggested setup for this procedure: 22g x 5 quincke needle (a 3.5 needle can also be used in most patients but might not be long enough in some patients) 2-3cc local anesthetic (such as dilute 0.125% bupivacaine) and desired steroid (such as dexamethasone 10mg) in 5cc syringe as primary injectate 3cc contrast 3-5cc 1% lidocaine in 5cc syringe with 25g x 1.5 hypodermic needle for subcutaneous anesthetic Landmarks and Patient Positioning Position the patient in a basic prone position so that the bottom of the c-arm can go under the table below the hip/sacrum on the treatment side

Massage in gentle upward circular motions until fully absorbed

10.1016/j.tifs.2019.03.005 136 WangM.YangG.TianY.ZhangQ.LiuZ.XinY

Avoid vigorous agitation or direct impact with the peptide cake