Peroneal Tendon Sheath Injection

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Peroneal Tendon Sheath Injection
Indication

Indications and Efficacy

In a study of 96 patients who had peroneal tendon sheath injections, 25% progressed to surgery. 43.7% reported 0-1 weeks of pain relief, 12.6% 2-6 weeks, 6.9% 7-12 weeks, and 36.8% greater than 12 weeks. Preinjection duration of symptoms was associated with post-injection duration of pain relief (P=.036). Patients with less than 1 year of symptoms had a median 6-12 weeks of postinjection pain relief.

Technique

Ultrasound Guided

Ultrasound guided in-plane peroneal tendon sheath injection

• Position: Lateral decubitus
• Outline distal fibula with a pen
• Clean area with alcohol, and load 1mL of 1% lidocaine and 1mL of 40mg triamcinolone.
• 25-gauge 1.5-inch needle
• High frequency probe in transverse position
• Visualise tendons running together at the level of the distal fibula
• Visualise needle during injection to confirm intrasheath, extratendinous injection.

Landmark Guided

Landmark guidance is only 60% accurate, vs 100% accurate for ultrasound.

Complications

In a study of 96 patients, there were 2 reported complications (1.8%): 1 case of self-limited sural nerve irritation and 1 of peroneus longus tear progression.

Literature Review

Literature Review

Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf

Articles from all years: PubMed search, Google Scholar search.

TRIP Database: clinical publications about evidence-based medicine.

Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,