PM&R
Volume 2, Issue 4 , Pages 277-281, April 2010

Ultrasound-guided versus Nonguided Tibiotalar Joint and Sinus Tarsi Injections: A Cadaveric Study

  • Steve J. Wisniewski, MD

      Affiliations

    • Physical Medicine and Rehabilitation, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905⁎
    • Corresponding Author InformationAddress correspondence to: S.J.W.
    • ,
  • Jay Smith, MD

      Affiliations

    • Physical Medicine and Rehabilitation, College of Medicine, Mayo Clinic, Rochester, MN†
    • ,
  • Denis G. Patterson, DO

      Affiliations

    • Nevada Advanced Pain Specialists, Reno, NV‡
    • ,
  • Stephen W. Carmichael, PhD

      Affiliations

    • Department of Anatomy, College of Medicine, Mayo Clinic, Rochester, MN§
    • ,
  • Wojciech Pawlina, MD

      Affiliations

    • Department of Anatomy, College of Medicine, Mayo Clinic, Rochester, MN∥

Received 25 November 2009; accepted 8 March 2010.

Objective

To compare the relative accuracy rates of ultrasound (US)-guided versus nonguided ankle (tibiotalar) joint and sinus tarsi injections in a cadaveric model.

Design

Prospective human cadaveric study with injection technique randomized and accuracy assessed by skilled observers blinded to injection technique.

Setting

Procedural skills laboratory in a tertiary care academic medical center.

Methods

Twelve embalmed and 8 unembalmed cadavers (40 ankles) were used for this investigation. Using a predetermined randomization process, 1 ankle of each cadaver was injected with US guidance and the other without. Tibiotalar joint injections were performed via an anterior approach and sinus tarsi injections performed via an anterolateral approach. All injections were performed by the senior author using a 22-gauge, 1.5-inch needle to place 3 mL of 50% diluted blue latex solution into the target area. Two anatomists blinded to the injection technique dissected each ankle and determined injection accuracy based on previously agreed upon criteria.

Main Outcome Measurements

Injection accuracy, where an accurate injection delivered injectate within the tibiotalar joint or into the mid-portion of the sinus tarsi.

Results

The accuracy rate for US-guided tibiotalar joint injections was 100% (20/20) versus 85% (17/20) for nonguided injections. The accuracy rate for US-guided sinus tarsi injections was 90% (18/20) versus 35% (7/20) for nonguided injections.

Conclusions

In this cadaveric study, US guidance produced superior accuracy compared with nonguided injections with respect to both the tibiotalar joint and sinus tarsi. Although further research is warranted, clinicians should consider US guidance to optimize injectate placement into these areas when optimal accuracy is necessary for diagnostic or therapeutic purposes.

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  • ⁎ Disclosure: nothing to disclose
  • † Disclosure: 2A, Tenex; 3A, Gulf Coast Ultrasound Institute
  • ‡ Disclosure: nothing to disclose
  • § Disclosure: nothing to disclose
  • ∥ Disclosure: nothing to disclose

 Funded by Mayo Clinic Department of PM&R small grants program.

 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org

PII: S1934-1482(10)00203-0

doi:10.1016/j.pmrj.2010.03.013

PM&R
Volume 2, Issue 4 , Pages 277-281, April 2010

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