Sonographically Guided Popliteus Tendon Sheath Injection

Abstract

Sonographic guidance can be used to inject the popliteus tendon sheath with a high degree of accuracy. Although the longitudinal approach is potentially more accurate, both approaches may result in injectate overflow into the knee joint, likely through the popliteus hiatus.

Sonographically Guided Semimembranosus Bursa Injection: Technique and Validation

“…Previous studies have demonstrated that ultrasound guidance may improve efficacy compared with nonguided injections when utilized in various body regions, presumably because of greater accuracy [15,[18][19][20][21][24][25][26][27]. Although no prior study has examined the accuracy or efficacy of SG SM bursa injections, Weiser [13] noted that only 58% of patients with clinically diagnosed SM tendinopathy/bursopathy responded to a single palpationguided injection.…”

“…Consequently, clinicians may consider utilizing precisely placed diagnostic injections to identify the pain generator(s) and facilitate appropriate management in patients presenting with medial knee pain syndromes [15,16]. Furthermore, image-guided therapeutic injections may produce a more predictable benefit than palpationguided injections [13,[15][16][17][18][19][20][21][22][23][24][25][26][27][28]. The role of sonographically guided (SG) diagnostic and interventional procedures in musculoskeletal and sports medicine is well established [15,[18][19][20][21]28,29].…”

American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine

“…Most studies evaluated injections into a single structure (42/49 (86%)),17 51 54 69 80 84–87 90–95 97–101 103–113 115–125 but seven studies (14%) investigated injections into more than one structure 52 71 88 89 96 102 114. In decreasing frequency, studies evaluated injections into bursae (19/49 (39%)),17 51 52 54 69 87 91–93 95 97 100 101 103 105 110 115 121 123 tendon sheaths (9/49 (18%)),71 89 102 106 108 111–113 116 tendons or fascia (8/49 {(16%)),96 102 107 112 119 120 124 125 perineural regions (6/49 (12%)),85 88 94 104 109 122 muscles (5/49 (10%)),86 97 114 117 118 cysts (2/49 (4%)),84 90 peritendinous regions (2/49 (4%)),71 102 wounds (1/49 (2%))52 and periarticular spaces (1/49 (2%)) 80…”

“…Four level 1 or 2 studies evaluating the accuracy of tendon sheath or peritendinous injections were identified 71 99 113 116. Multiple regions were evaluated including the Achilles peritendinous region,71 and the tendon sheaths of the long head biceps,99 first dorsal wrist compartment, flexor hallucis longus,71 tibialis posterior,71 popliteus116 and peroneal (fibularis) tendons 113. Although the criteria used to define ‘accurate injections’ were different in the various studies, the mean reported accuracy of USGIs into tendon sheaths or peritendinous regions ranged from 87% to 100%, while the mean accuracy of LMGIs ranged from 27% to 60%.…”

Ultrasound-assisted musculoskeletal procedures: A practical overview of current literature

“…Evidence has demonstrated that ultrasound-guided tendon injection reduces pain both during and after the injection, decreases overall patient discomfort, and improves joint or muscle mobility more than traditional blind injections [16][17][18][19] . Furthermore, ultrasound-guided intra-articular injections enable the practitioner to localize fluid collections and perform simultaneous arthrocentesis [17] (Table 2).…”