Ultrasound guided injection of the subtalar joint

NewsBot · Oct 27, 2009

Members do not see these Ads. Sign Up.
Accuracy of sonographically guided posterior subtalar joint injections: comparison of 3 techniques.
Smith J, Finnoff JT, Henning PT, Turner NS.
J Ultrasound Med. 2009 Nov;28(11):1549-57.

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.
Click to expand...

facfsfapwca · Oct 29, 2009

NewsBot said: ↑

Accuracy of sonographically guided posterior subtalar joint injections: comparison of 3 techniques.
Smith J, Finnoff JT, Henning PT, Turner NS.
J Ultrasound Med. 2009 Nov;28(11):1549-57.

Click to expand...

A second study should be done showing accuracy without Ultra sound.

Mart · Oct 30, 2009

facfsfapwca said: ↑

A second study should be done showing accuracy without Ultra sound.
Click to expand...

Already done albeit with slightly different methodolgy.

:santa:

Martin

The St. James Foot Clinic
1749 Portage Ave.
Winnipeg
Manitoba
R3J 0E6
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com

Accuracy of posterior subtalar joint injection without fluoroscopy
Kirk, K.L.a , Campbell, J.T.b , Guyton, G.P.a , Schon, L.C.a
a Department of Orthopaedic Surgery, Union Memorial Hospital, 3333 N Calvert Street, Baltimore, MD 21218, United States
b Institute for Foot and Ankle Reconstruction at Mercy, Mercy Medical Center, Baltimore, MD, United States

Abstract
Injection into the posterior subtalar joint has not been validated for accuracy using radiographic end points. We asked whether needle placement into a normal posterior subtalar joint could be performed accurately and selectively by experienced surgeons without fluoroscopic guidance. Three fellowship-trained orthopaedic foot and ankle surgeons each injected the posterior subtalar joint of 20 cadaveric specimens using an anterolateral approach. Fluoroscopic images were obtained by an independent investigator and blinded. A separate fellowship-trained foot and ankle surgeon interpreted the images. Of 60 injections, 58 were accurate and two were extraarticular based on interpretation by an independent foot and ankle surgeon. Extravasation into the ankle occurred in 14 samples and into the peroneal sheath in two samples. Experienced surgeons can place intraarticular injections into a radiographically normal posterior subtalar joint without fluoroscopy with a high degree of accuracy. However, extravasation into the ankle or peroneal tendon sheath occurred in an unpredictable fashion, suggesting selectivity of injection placement is relatively limited without the use of fluoroscopy. Fluoroscopy may not be necessary for injections used solely for therapeutic purposes. However, if the injection is intended for diagnostic purposes or to assist in surgical decision-making or if the joint is abnormal, we recommend fluoroscopy to ensure the subtalar joint is the only anatomic structure impacted by the injection. © 2008 The Association of Bone and Joint Surgeons.

NewsBot · Aug 29, 2021

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part VI, foot and ankle
Luca Maria Sconfienza et al
Eur Radiol. 2021 Aug 25.

Objectives: Clarity regarding accuracy and effectiveness for interventional procedures around the foot and ankle is lacking. Consequently, a board of 53 members of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the published literature to evaluate the evidence on image-guided musculoskeletal interventional procedures around this anatomical region.

Methods: We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around foot and ankle in order to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper that was shared with all panel members for final approval.

Results: A list of 16 evidence-based statements on clinical indications for image-guided musculoskeletal interventional procedures in the foot and ankle were drafted after a literature review. The highest level of evidence was reported for four statements, all receiving 100% agreement.

Conclusion: According to this consensus, image-guided interventions should not be considered a first-level approach for treating Achilles tendinopathy, while ultrasonography guidance is strongly recommended to improve the efficacy of interventional procedures for plantar fasciitis and Morton's neuroma, particularly using platelet-rich plasma and corticosteroids, respectively.

Key points: • The expert panel of the ESSR listed 16 evidence-based statements on clinical indications of image-guided musculoskeletal interventional procedures in the foot and ankle. • Strong consensus was obtained for all statements. • The highest level of evidence was reached by four statements concerning the effectiveness of US-guided injections of corticosteroid for Morton's neuroma and PRP for plantar fasciitis.
Click to expand...

NewsBot The Admin that posts the news.

facfsfapwca Active Member

Mart Well-Known Member

NewsBot The Admin that posts the news.

Full-length silicone insoles versus ultrasound-guided corticosteroid injection in the management of

Ultrasound guided corticosteroid injection for plantar fasciitis

Ultrasound guided steroid injections

Ultrasound guided dextrose injection for achilles tendonitis & plantar fasciitis

Ultrasound-guided Microtenotomy & IASTM

Ultrasound clinical references of the healthy toenail unit

Plantar forefoot pain: ultrasound findings before and after treatment with custom-made foot orthoses

Share This Page