This Article Full Text Full Text (PDF) Earn FREE CME Credit __AIUM Journal Club discussion article Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Smith, J. Articles by Turner, N. S. PubMed PubMed Citation Articles by Smith, J. Articles by Turner, N. S.

Accuracy of Sonographically Guided Posterior Subtalar Joint Injections

Comparison of 3 Techniques

Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Mayo Clinic Sports Medicine Center (J.S., J.T.F., P.T.H.), Rochester, Minnesota USA; Department of Radiology, Mayo Clinic Sports Medicine Center, Rochester, Minnesota USA (J.S.); and Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota USA (N.S.T.).

Address correspondence to Jay Smith, MD, Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, E10, Mayo Building, 200 First St SW, Rochester, MN 55905 USA. E-mail: smith.jay{at}mayo.edu

Objective. The primary purpose of this investigation was to determine the accuracy of 3 different sonographically guided posterior subtalar joint (PSTJ) injection techniques in an unembalmed cadaveric model. Methods. A single experienced examiner injected the PSTJs of 12 unembalmed cadaveric ankle-foot specimens using the anterolateral, posterolateral, and posteromedial approaches. The injection order for each specimen was randomized, and each technique was completed with a different-color diluted latex solution. Coinvestigators blinded to the injection technique dissected each specimen and graded the colored latex location as accurate (in the PSTJ), accurate with overflow (within the PSTJ but also in other regions), or inaccurate (no latex in the joint). Results. All 3 sonographically guided PSTJ injection approaches accurately placed latex into the PSTJ (100% accuracy). Latex was also found in adjacent regions in 19.4% (7 of 36) of injections: 8.3% (3 of 36) within the tibiotalar joint, 8.3% (3 of 36) in the peroneal (fibularis) tendon sheath, and 2.8% (1 of 36) in the flexor hallucis longus tendon sheath. The anterolateral approach placed latex outside the PSTJ 25% of the time (3 of 12 injections: 1 tibiotalar and 2 peroneal [fibularis] sheath), the posterolateral approach 25% of the time (3 of 12 injections: 1 tibiotalar, 1 peroneal [fibularis] sheath, and 1 flexor hallucis longus tendon sheath), and the posteromedial approach 8.3% of the time (1 tibiotalar). Conclusions. This cadaveric investigation suggests that all 3 sonographically guided PSTJ techniques may be used to access the PSTJ with a high degree of accuracy. Clinicians should consider sonographically guided PSTJ injections as a favorable alternative to fluoroscopy and computed tomographic guidance when diagnostic or therapeutic image-guided PSTJ injections are indicated.

Key Words: ankle injection • hindfoot • sonography • subtalar

Abbreviations: CT, computed tomographic • PSTJ, posterior subtalar joint