Factors affecting successful ultrasound-guided injection into the podotrochlear bursa using a palmarolateral approach.

OBJECTIVE To evaluate potential factors affecting ultrasonographic visibility of the suprasesamoidean region and the success rate of ultrasound-guided injection (USGI) into the podotrochlear bursa (PB). STUDY DESIGN Ex vivo, experimental study. ANIMALS 24 cadaveric forelimbs. METHODS The PB was distended with 0, 1, or 2 ml of iodinated contrast material and saline under radiographic guidance. Ultrasonographic visibility of the suprasesamoidean region and PB was graded before and after distention with the limb loaded in three positions (vertical, cranial and caudal). Two operators with different experience levels performed an USGI into the PB with methylene blue (12 limbs each [four limbs with each of three volumes of PB distension]) using a palmarolateral approach and caudal foot placement. Limbs were frozen and sectioned to assess accuracy. RESULTS Ultrasonographic visibility scores of the suprasesamoidean region (p = .0081) and PB (p < .0001) were improved using a caudal foot placement. Higher visibility grades of the suprasesamoidean region were associated with higher injection success rate (p = .047). The injection success was 75% (9/12) for the experienced versus 41.6% (5/12) for the less experienced operator (p = .14). PB distension improved visibility during caudal foot placement (p = .013) but not injection success rates (p = .78). CONCLUSION Caudal foot placement enhances visibility of the PB and suprasesamoidean region. Limbs with poor visibility of the suprasesamoidean region are more likely to undergo a failed USGI. CLINICAL SIGNIFICANCE The lateral USGI approach should be performed only in cases of optimal visibility. The reported success rates support the technical challenge of PB injections.