jultrasoundmed.org/content/34/1/83.abstract Sonographically Guided Posterior Subtalar Joint Injections via the Sinus Tarsi Approach Jay Smith, MD⇑, Eugene Maida, MB, ChB, Naveen S. Murthy, MD, Eugene Y. Kissin, MD and Jon A. Jacobson, MD + Author Affiliations Departments of Physical Medicine and Rehabilitation (J.S.), Radiology (J.S., N.S.M.), and Anatomy (J.S.), Mayo Clinic College of Medicine, Rochester, Minnesota USA; Department of Physical Medicine and Rehabilitation, McMaster University, Hamilton, Ontario, Canada (E.M.); Division of Rheumatology, Boston University School of Medicine, Boston, Massachusetts USA (E.Y.K.); and Department of Radiology, University of Michigan, Ann Arbor, Michigan USA (J.A.J.). Address correspondence to Jay Smith, MD, Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Building, 200 First St SW, 14th Floor, Rochester, MN 55905 USA. E-mail: [email protected] Abstract Objectives—To determine the feasibility and accuracy of sonographically guided posterior subtalar joint (PSTJ) injections performed through the sinus tarsi. Methods—A single experienced operator completed 10 sonographically guided PSTJ injections via the sinus tarsi on 10 unembalmed cadaveric ankle-foot specimens. Injections were performed using a 17–5-MHz linear transducer, a 25-gauge, 50-mm needle, and an out-of-plane, anterior-to-posterior needle trajectory parallel to the calcaneal surface. Sonographic assessment for fluid in the posterior and lateral PSTJ recesses, sinus tarsi, and peroneal tendon sheath was performed before and after injections of 2 and 4 mL of tap water. Two additional specimens were injected with a contrast agent: 1 via the sonographically guided approach and another by a computed tomographically guided approach. Results—All 10 sonographically guided PSTJ tap water injections were accurate, distending both the posterior and lateral PSTJ recesses. In addition, all 10 specimens showed posterior recess distension by 2 mL, whereas only 2 specimens (20%) showed lateral recess distension at this volume. By 4 mL, both recesses were clearly distended in all specimens. Both contrast agent injections produced similar PSTJ computed tomographic arthrograms and patterns of recess distension similar to the sonographically guided tap water injections. No sonographically guided PSTJ injection placed fluid in the peroneal tendon sheath. Conclusions—Sonographically guided PSTJ injections via the sinus tarsi can accurately and specifically deliver injectate into the PSTJ while monitoring injectate flow within the posterior recess. The sinus tarsi approach may be used as an alternative technique to perform sonographically guided PSTJ injections when clinically appropriate.
Posted on: Sat, 27 Dec 2014 10:24:50 +0000
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