title: Ultrasound-guided versus nonguided tibiotalar joint and sinus tarsi injections: a cadaveric study.
abstract: OBJECTIVE
  To compare the relative accuracy rates of ultrasound (US)-guided versus nonguided ankle (tibiotalar) joint and sinus tarsi injections in a cadaveric model.
  
  
  METHODS
  Prospective human cadaveric study with injection technique randomized and accuracy assessed by skilled observers blinded to injection technique.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Physical Medicine and Rehabilitation, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA. wisniewski.stephen@mayo.edu
authors.forename: Steve J
authors.initials: SJ
authors.lastname: Wisniewski
authors.forename: Jay
authors.initials: J
authors.lastname: Smith
authors.forename: Denis G
authors.initials: DG
authors.lastname: Patterson
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Carmichael
authors.forename: Wojciech
authors.initials: W
authors.lastname: Pawlina
mesh_terms: D000843:Ankle Joint; D002102:Cadaver; D004396:Coloring Agents / Q000008:administration & dosage; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods*; D007840:Latex / Q000008:administration & dosage; D010173:Palpation; D015203:Reproducibility of Results; D025321:Surgery, Computer-Assisted; D013640:Tarsal Joints; D018084:Ultrasonography, Interventional
chemical_list: D004396:Coloring Agents; D007840:Latex