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The Accuracy of Ultrasound-Guided and Palpation-Guided Peroneal Tendon Sheath Injections

Muir, Jeffery J. MD; Curtiss, Heather M. MD; Hollman, John PT, PhD; Smith, Jay MD; Finnoff, Jonathan T. DO

American Journal of Physical Medicine & Rehabilitation: July 2011 - Volume 90 - Issue 7 - p 564-571
doi: 10.1097/PHM.0b013e31821f6e63
Original Research Articles: Ultrasound

Objective: The aim of this study was to describe and to validate an ultrasound-guided peroneal tendon sheath (PTS) injection technique and to compare the accuracy of ultrasound-guided vs. palpation-guided PTS injections in a cadaveric model.

Design: Twenty cadaveric lower limbs were injected with and without ultrasound guidance, using a different color of liquid latex for each injection technique. The injections were performed by a single investigator in a randomized order. Cadaveric specimens were dissected 1 wk later by a blinded investigator who graded injection accuracy on a 3-point scale (1, accurate; 2, partially accurate; 3, inaccurate).

Results: Ultrasound-guided injections were 100% (20 of 20) accurate whereas palpation-guided injections were 60% (12 of 20) accurate (P = 0.008). Six palpation-guided injections were partially accurate, and two were inaccurate. Two of the partially accurate and both of the inaccurate injections were intratendinous.

Conclusions: In a cadaveric model, ultrasound-guided PTS injections are significantly more accurate than palpation-guided injections. When performing PTS injections, clinicians should consider ultrasound guidance to improve injection accuracy and minimize potential complications such as intratendinous injection.

From the Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota.

All correspondence and requests for reprints should be addressed to Jonathan T. Finnoff, DO, Department of PM&R, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Disclosures: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Supported by the Small Grants Program through the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN.

Presented, in part, as a poster at the American Society of Regional Anesthesia and Pain Medicine Annual Pain Medicine Meeting in Phoenix, AZ, November 18-21, 2010.

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