Ultrasound-Guided Ankle Joint Injection
This chapter includes injection of the tibiotalar and subtalar joints and the five nerves for an ankle block.
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Phuong Uyen Le, Marline Sangnil, Karina Gritsenko, and Soo Yeon Kim
This chapter includes injection of the tibiotalar and subtalar joints and the five nerves for an ankle block.
Indications Indications for a tibiotalar joint injection include pain that is secondary to osteoarthritis, rheumatoid arthritis, acute traumatic arthritis, crystalloid deposition disease, mixed connective tissue disease, and synovitis. Indications for a subtalar joint injection include pain that is associated with arthritis. Patients may present with heel pain that is worse with ambulation.
CPT20605, 76942 P.U. Le, DO Physical Medicine and Rehabilitation, Montefiore Medical Center/Albert Einstein College of Medicine, 2nd Floor, 150 East 210th Street, Bronx 10467, NY, USA e-mail: [email protected] M. Sangnil, MD Physical Medicine and Rehabilitation, Case Western Reserve University/MetroHealth Medical Center, 2500 MetroHealth Dr, Cleveland 44107, OH, USA e-mail: [email protected]
Equipment/Materials Ultrasound probe 12–5 MHz (5–16 MHz to 17–5 MHz are preferable), 20- to 25-gauge 1.5-in needle, 1 % lidocaine for local anesthesia, 5-mL syringe, sterile ultrasound gel and probe cover, 4 × 4 gauze pads, sterile drapes, adhesive bandage and sterile cleansing solution,+/− corticosteroid.
K. Gritsenko, MD (*) Department of Anesthesiology, Albert Einstein College of Medicine, Montefiore Medical Center, 3400 Bainbridge Ave, LL400, Bronx, NY 10128, USA e-mail: [email protected]
Tibiotalar Joint Injection
S.Y. Kim, MD Physical Medicine and Rehabilitation, Montefiore Medical Center, 8th Floor, Tower 2, 1250 Waters pl, Bronx 10461, NY, USA e-mail: [email protected]
Steps: 1. Clean the skin around the ankle thoroughly with an antiseptic agent such as chlorhexidine or alcohol. After the skin is dry, place sterile
Position: supine with knee bent and foot flat on the examination table (Fig. 100.1a).
© Springer International Publishing Switzerland 2017 R.J. Yong et al. (eds.), Pain Medicine, DOI 10.1007/978-3-319-43133-8_100
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Fig. 100.1 Tibiotalar joint injection. (a) Patient position. (b) Probe and needle placement
ultrasound gel on the probe and cover the probe with sterile plastic. 2. Place the probe using the dorsal long axis approach. The probe is placed in the long axis with respect to the tibialis anterior tendon and positioned medially to the tendon (Fig. 100.1b). 3. Identify and avoid the dorsalis pedis artery. 4. When the anterior recess of the tibiotalar joint is localized, insert the needle, directing the needle from distal to proximal (Fig. 100.1b). 5. Aim the needle toward the underside of the tibia (Fig. 100.2) and aspirate to rule out intravascular injection. 6. Inject the medication, remove the needle, and apply an adhesive bandage.
Subtalar Joint Injection Position: The ankle is positioned with the lateral side facing upward. Place the ankle in subtalar inversion (a towel may be placed under the ankle) (Fig. 100.3).
Steps: 1. Clean the skin around the ankle thoroughly with an anti
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