Now dr. manaan what is the difference between the ultrasound and the fluoroscopy good question normally fluoroscopy will be x-ray so we don’t see the soft tissues meaning we don’t see the the nerve we don’t see the disc and typically speaking fluoroscopy we do them mainly for for spine also can be done for joinings actions like shoulder in what we do shoulder injection inside the joint not for the bursa just for the joint itself for the hip joint do they have arthritis that’s fine because we we can see also with with fluoroscopy the that area now for soft tissues meaning the versus the tendons the nerve in the periphery normally is being recommended under ultrasound guided spinal injections are there some studies come going for ultrasound guided but nowadays kind of care is doing them on their fluoroscopic guidance it’s it’s simpler it’s easier to do on their x-rays quicker and faster and how effective are the injections the injection it depends on unfortunately some patient they might not respond to the injection so normally we as we as we manage the patient we go from the least invasive towards their more invasive in terms of treatment so something we started the patients on our physical therapy program they failed those are the candidate are for injection a lot of time the physical therapy program might help the patients sometimes they don’t we might need to get them an injection and unfortunately some patients might not respond all those are the one that most for the most part they can become a surgical candidate doctor Mina is this covered by insurance the injections are they are do covered by insurance obviously there has to be a medical necessity as to why we’re doing an injection we have to document that they can has failed conservative care meaning physical therapy for about four to six weeks or the patient cannot start or they can not undergo a physical therapy for reason for which they are in significant amount of pain that we may need to do an injection prior to bring some of that inflammation down to allow them to to have the to opt injection you