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. Materials and 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.

Outcomes after fluoroscopy-guided iliopsoas bursa injection for suspected iliopsoas tendinopathy

“…Interestingly, more patients showed clinically significant improvement after 1 week and 1 month compared to after 1 day. This finding is consistent with other studies [20] and can be explained by the known short anaesthetic efficacy of lidocaine (up to 5 h, according to the manufacturer's data) and the late onset effect of the applied corticosteroid. So after 1 day, the effect of lidocaine is gone and the effect of triamcinolone is not yet fully established.…”

Fluoroscopic-guided procedures of the lower extremity

“…The skin overlying the posterior subtalar joint is marked just lateral to the Achilles tendon and the needle is inserted and directed from lateral to the central subtalar joint (Fig. 22 ) [ 79 ]. A potential drawback to this approach is the risk of sural nerve injury which lies in close to proximity to the expected needle trajectory.…”