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PM R. 2009 Oct;1(10):925-31. doi: 10.1016/j.pmrj.2009.09.006.

Sonographically guided posterior subtalar joint injections: anatomic study and validation of 3 approaches.

Author information

1
Department of Physical Medicine & Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, MN, USA.

Abstract

OBJECTIVE:

To describe and validate 3 different approaches to perform sonographically guided posterior subtalar joint (PSTJ) injections.

DESIGN:

Sonographically guided procedures performed on cadaveric specimens.

SETTING:

Procedural skills lab at a tertiary medical facility.

METHODS:

Three ultrasound-guided approaches to inject the PSTJ: anterolateral, posteromedial, and posterolateral were derived based on anatomic review, published fluoroscopic and computed tomography (CT) techniques, and clinical experience. Three separate unembalmed cadaveric ankle-foot specimens were injected by a single, experienced operator using a 25-gauge, 38-mm stainless steel needle. A different approach was used on each specimen. The needles were left in place and each specimen was subsequently dissected by co-investigators to confirm accurate needle placement and determine the proximity of each needle to local tendons and neurovascular structures.

MAIN OUTCOME MEASUREMENTS:

Direct assessment of needle placement within posterior subtalar joint.

RESULTS:

All 3 approaches provided accurate needle placement into the posterior subtalar joint while avoiding nearby tendinous and neurovascular structures.

CONCLUSIONS:

Sonographically guided PSTJ injections are technically feasible. All 3 approaches provide accurate needle placement while minimizing the risk of needle entry into adjacent soft tissue structures not visualized by other modalities such as fluoroscopy or CT.

PMID:
19854421
DOI:
10.1016/j.pmrj.2009.09.006
[Indexed for MEDLINE]

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