title: Sonographically guided proximal tibiofibular joint injection: technique and accuracy.
abstract: OBJECTIVE
  The purpose of this investigation was to describe a technique for sonographically guided proximal tibiofibular joint (PTFJ) injections and compare its accuracy with that of palpation guided injections in a cadaveric model.
  
  
  METHODS
  A single experienced operator completed 12 sonographically guided and 12 palpation guided PTFJ injections in unembalmed cadavers. The injection order was randomized, and all injections were completed with diluted colored latex. Coinvestigators blinded to the injection technique dissected each specimen and graded the colored latex location as accurate (in the PTFJ), accurate with overflow (within the PTFJ but also in other regions), or inaccurate (no latex in the joint). For statistical analysis, all injections placing latex within the PTFJ were considered "accurate," whereas "inaccurate" injections resulted in no PTFJ latex.
  
  
  RESULTS
  All 12 sonographically guided PTFJ injections accurately placed latex into the PTFJ (100% accuracy), whereas only 7 of 12 palpation guided injections (58%) placed latex within the PTFJ (P = .01). All 5 inaccurate palpation guided injections were superficial and inferior to the PTFJ. Four of 12 accurate sonographically guided PTFJ injections (33%) showed some overflow into the adjacent anterior musculature, whereas 5 of the accurate palpation guided injections (42%) resulted in overflow into the anterior musculature (1), knee joint (2), or both (2).
  
  
  CONCLUSIONS
  This cadaveric investigation suggests that sonographic guidance can be used to inject the PTFJ with a high degree of accuracy and should be considered superior to palpation guidance. Clinicians should consider using sonographic guidance to inject the PTFJ for diagnostic or therapeutic purposes when clinically indicated.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, MN 55905, USA. smith.jay@mayo.edu
authors.forename: Jay
authors.initials: J
authors.lastname: Smith
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Finnoff
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Levy
authors.forename: Jim K
authors.initials: JK
authors.lastname: Lai
mesh_terms: D000843:Ankle Joint / Q000000981:diagnostic imaging*; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods*; D008954:Models, Biological; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional / Q000379:methods*