Ultrasound-Guided Intra-articular Ankle Injection

Michael N. Brown

Michael Gofeld

Background and indications: The accuracy of ultrasound-guided talotibial joint injections has been evaluated and shown in one study to be 100% (20 out of 20) versus 85% (17 out of 20) for nonguided injections.¹ The accuracy rate for ultrasound-guided sinus tarsi injections was 90% (18 out of 20) versus 35% (7 out of 20) for nonguided injections in a cadaver study utilizing methylene blue for confirmation.¹ The improved accuracy rate for intra-articular injections has made ultrasound increasingly popular for both diagnostic and injection procedures. In addition, ultrasound has been shown to have a higher sensitivity than examinations and x-rays in detecting synovitis and joint erosions and appears to be similar or even superior to other imaging techniques such as magnetic resonance imaging (MRI) for this purpose.²^,³ In the case of gouty arthritis, ultrasound was found to be more effective at detecting bone erosions in comparison to x-rays in symptomatic as well as asymptomatic joints.⁴^,⁵ Intra-articular injections of hyaluronic acid (HA) for ankle osteoarthritis have also been evaluated. Sun et al.⁶ evaluated 46 patients with unilateral ankle arthritis who were receiving three weekly HA injections and reported pain relief and improved function. Evidence is still weak with regard to the use of HA in ankle osteoarthritis. Part of the problem is the complexity of the weight-bearing stress and biomechanics of the ankle joint.