• Jeffery J Muir, Heather M Curtiss, John Hollman, Jay Smith, and Jonathan T Finnoff.
• Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota, USA.
• Am J Phys Med Rehabil. 2011 Jul 1; 90 (7): 564-71.

ObjectiveThe aim of this study was to describe and to validate an ultrasound-guided peroneal tendon sheath (PTS) injection technique and to compare the accuracy of ultrasound-guided vs. palpation-guided PTS injections in a cadaveric model.DesignTwenty cadaveric lower limbs were injected with and without ultrasound guidance, using a different color of liquid latex for each injection technique. The injections were performed by a single investigator in a randomized order. Cadaveric specimens were dissected 1 wk later by a blinded investigator who graded injection accuracy on a 3-point scale (1, accurate; 2, partially accurate; 3, inaccurate).ResultsUltrasound-guided injections were 100% (20 of 20) accurate whereas palpation-guided injections were 60% (12 of 20) accurate (P = 0.008). Six palpation-guided injections were partially accurate, and two were inaccurate. Two of the partially accurate and both of the inaccurate injections were intratendinous.ConclusionsIn a cadaveric model, ultrasound-guided PTS injections are significantly more accurate than palpation-guided injections. When performing PTS injections, clinicians should consider ultrasound guidance to improve injection accuracy and minimize potential complications such as intratendinous injection.

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