title: The posterolateral fluoroscopy-guided injection technique into the posterior subtalar joint: description of the procedure and pilot study on patient outcomes.
abstract: OBJECTIVE
  To describe a posterolateral fluoroscopy-guided injection technique into the posterior subtalar joint and to report patient outcomes 1 month post-injection.
  
  
  METHODS
  Twenty-three consecutive adult patients who underwent fluoroscopy-guided injection into the posterior subtalar joint using a direct posterolateral approach and who returned an outcomes-based postal questionnaire after receiving this injection were included. Numerical pain rating scale (NRS) data were collected prior to injection. NRS and Patient's Global Impression of Change (PGIC) scales were completed 1 day, 1 week, and 1 month after injection. The proportion of patients who improved was calculated for each time period. Baseline NRS data were compared to each time point using the Wilcoxon test to assess differences. Spearman's correlation coefficient was used to compare the 20 min NRS score with all follow-up NRS scores. All available images were reviewed for the presence of subtalar osteoarthritis (OA). Patient charts were reviewed to identify characteristics of patients referred for subtalar injections. Risk ratios were calculated comparing presence of OA or other abnormalities with improvement.
  
  
  RESULTS
  A posterolateral approach for fluoroscopy-guided injections into the subtalar joint is described. There was a significant reduction in the mean NRS score at all time periods compared to baseline (p ≤ 0.004). One-third of patients (7/21) reported clinically relevant improvement at 1 month.
  
  
  CONCLUSIONS
  Fluoroscopy-guided puncture of the posterior subtalar joint using a posterolateral approach is possible. Clinically significant improvement is reported in 33% of patients after 1 month.
authors.affiliation: Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland. pixdoc@gmail.com
authors.forename: Florian M
authors.initials: FM
authors.lastname: Buck
authors.forename: Christian W A
authors.initials: CW
authors.lastname: Pfirrmann
authors.forename: Florian
authors.initials: F
authors.lastname: Brunner
authors.forename: Juerg
authors.initials: J
authors.lastname: Hodler
authors.forename: Cynthia
authors.initials: C
authors.lastname: Peterson
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D018771:Arthralgia / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D001175:Arthrography / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007269:Injections, Intra-Arterial / Q000379:methods; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015641:Radiography, Interventional / Q000379:methods*; D013380:Subtalar Joint / Q000000981:diagnostic imaging* / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local