title: Fluoroscopically guided retrocalcaneal bursa steroid injection: description of the technique and pilot study of short-term patient outcomes.
abstract: OBJECTIVE
  To describe a lateral fluoroscopically guided retrocalcaneal bursa injection technique, report patient outcomes at 1-4 weeks after steroid/anesthetic retrocalcaneal bursal therapeutic injection, and correlate pre-injection diagnostic heel ultrasound variables with improvement in patient pain scores.
  
  
  METHODS
  After IRB approval, fluoroscopically guided therapeutic retrocalcaneal bursa injections performed using a lateral approach were retrospectively reviewed. Pre-injection heel ultrasound results and pre- and post-injection patient VAS pain scores (scale 0-10) were recorded. The Wilcox matched-pair test compared pain scores, and Spearman's rho assessed for correlation between pain score changes and heel ultrasound results.
  
  
  RESULTS
  Thirty-two injections were performed in 30 patients (25 females, 5 males; mean 56.5 ± 9.3 years, range 39-75 years; 21 left heel, 11 right heel) with technical success in 32 of 32 cases (100 %). Insertional Achilles tendon pathology and retrocalcaneal bursitis were present in 31 of 32 cases (97 %) and 16 of 32 cases (50 %), respectively. Median pre- and post-procedure pain scores were 8 (IQR 7, 10) and 1.75 (IQR 0, 6). A statistically significant decrease in pain score was observed following injection, with a median change of 4.75 (IQR 3, 8; p < 0.001). Clinically significant response (>50 % reduction in pain score) was present in 69 % (95 % CI, 0.52-0.86; p < 0.001). No significant correlation was identified between a decrease in pain score and a sonographically abnormal Achilles tendon or retrocalcaneal bursa.
  
  
  CONCLUSIONS
  Fluoroscopically guided retrocalcaneal bursal steroid/anesthetic using a lateral approach is an effective technique. This technique yielded 100 % technical success and a clinically significant decrease in patient pain scores (p < 0.001).
authors.affiliation: Musculoskeletal Division, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA. sgoldberg@montefiore.org.
authors.forename: Shlomit
authors.initials: S
authors.lastname: Goldberg-Stein
authors.affiliation: Musculoskeletal Division, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.
authors.forename: Netanel
authors.initials: N
authors.lastname: Berko
authors.affiliation: Musculoskeletal Division, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.
authors.forename: Beverly
authors.initials: B
authors.lastname: Thornhill
authors.affiliation: Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Elsinger
authors.affiliation: Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Walter
authors.affiliation: Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.
authors.forename: Dominic
authors.initials: D
authors.lastname: Catanese
authors.affiliation: Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Popowitz
mesh_terms: D000125:Achilles Tendon; D000368:Aged; D002061:Bursa, Synovial / Q000000981:diagnostic imaging*; D002062:Bursitis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005471:Fluoroscopy; D006365:Heel / Q000000981:diagnostic imaging; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D013256:Steroids
keywords: Musculoskeletal intervention; Retrocalcaneal bursitis; Steroid injection, fluoroscopic guidance