Cody Mark Young DO, Presenter: Nothing to Disclose

William Eugene Shiels DO, Abstract Co-Author: President, Mauka Medical Corporation Owner, Mauka Medical Corporation Patent holder, GRI Medical Products, Inc

Brian D. Coley MD, Abstract Co-Author: Nothing to Disclose

Mark Joseph Hogan MD, Abstract Co-Author: Nothing to Disclose

James Walter Murakami MD, Abstract Co-Author: Nothing to Disclose

To describe the technique for, and evaluate the safety and efficacy of treating the subtalar joint with ultrasound guided corticosteroid injections in patients with juvenile idiopathic arthritis.

A retrospective analysis was performed of 68 patients (age 1 – 26 years), with known juvenile idiopathic arthritis, who were referred by a pediatric rheumatologist for corticosteroid injection therapy for symptoms related to the hindfoot and/or ankle. In these patients, the diseased subtalar joint was targeted for therapy, often in conjunction with adjacent affected joints and/or tendon sheaths of the ankle. To access the subtalar joint, the ultrasound probe is placed in an oblique coronal plane just anterior and distal to the lateral malleolus with the foot held in slight supination. The needle is advanced into the joint in a plane perpendicular to the long axis of the probe, using a freehand technique. An age-weight-joint-based dose protocol was utilized for triamcinolone hexacetonide or triamcinolone acetonide dose prescription.

A total of 135 subtalar joint corticosteroid injections were performed under ultrasound guidance. These included 39 repeat injections for recurrent symptoms in 16 of the 68 patients (average of 2.4 repeat injections). The average time interval between repeat injections was 17.2 months (range, 2.2 - 50.9 months). Atrophy of overlying subcutaneous soft tissues was the only complication reported, occurring in 2.3% of subtalar injections.

With appropriate training and practice, the subtalar joint can be targeted reliably and safely with ultrasound guided corticosteroid injection to provide effective treatment of symptoms related to juvenile idiopathic arthritis.

The subtalar joint can be difficult to access for treatment of juvenile idiopathic arthritis but ultrasound guidance facilitates safe and accurate joint-targeted therapy.

Young, C, Shiels, W, Coley, B, Hogan, M, Murakami, J, Technique, Safety, and Efficacy of Ultrasound-guided Corticosteroid Injection of the Subtalar Joint for Treatment of Juvenile Idiopathic Arthritis.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11004085.html