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Popliteus Tendon Injection

From WikiSM

Other Names

  • Popliteus Tendon Injection
  • Popliteus Tendon Percutaneous Tenotomy

Background

Illustration of popliteus

Key Points

  • Needle: 20-25 gauge, 1.5 inch
  • Transducer: high frequency, linear

Anatomy of the Popliteus Tendon

Palpation Guidance vs Ultrasound Guidance

  • To date, there are no studies comparing ultrasound and palpation guided approaches
  • It is unlikely a proceduralist can reliable inject the popliteus tendon without ultrasound
  • For this reason, US guided injections are strongly recommended

Indications

Contraindications

  • Absolute
    • Anaphylaxis to injectates
    • Overlying cellulitis, skin lesion or systemic infection
  • Relative
    • Can be treated with less invasive means
    • Hyperglycemia or poorly controlled diabetes
    • Lack of symptom improvement with previous injection

Procedure

(A) Needle and probe position for long axis, in plane approach. (B) Needle and probe position for short axis, in plane approach. (C) Ultrasound view with needle in plane in the long axis approach. Note that the needle passes through the tendon to the deep side of the tendon sheath. Fibular collateral ligament (FCL) crosses obliquely superficial to the popliteus. (D) Ultrasound view with needle in plane in the short axis approach. Note that the SAX approach allows for injection into the deep aspect of the tendon sheath without passing through the tendon.[1]
Needle and probe position for tenotomy long axis in plane approach. Note this can also be used for tendon sheath injection[2]
Ultrasound view with needle in plane for tenotomy[2]

Equipment

  • Sterile prep (i.e. chloraprep, chlorhexidine, iodine, etc)
  • Gloves
  • Needle: typically 21-25 gauge, 1.5 inch
  • Syringe: 5-10 mL
  • Gauze
  • Ethyl Chloride
  • Bandage
  • Injectate
    • Local anesthetic
    • Corticosteroid
  • Sterile probe cover

Ultrasound Findings

  • Transducer: high frequency, linear
  • Can be visualized in long or short axis
  • Depth of less than 3 cm
  • Common ultrasound findings include:
    • Hypoechoic signal may indicate tendinopathy
    • Hyperechoic changes may suggest calcific tendinopathy

Tendon Sheath Injection: Short Axis, In Plane

  • Patient Position
    • Contralateral decubitus position
    • Knee flexed to 20-30 degrees, internally rotated slightly
  • Transducer position
    • Short axis to tendon
  • Needle Approach/ Orientation
    • In plane
    • Proximal-to-distal/ distal-to-proximal
  • Target
    • Popliteus tendon sheath
  • Pearls and Pitfalls
    • Identify and avoid the common peroneal nerve

Tenotomy: Long Axis, In Plane

  • Patient Position
    • Contralateral decubitus position
    • Knee flexed to 20-30 degrees, internally rotated slightly
  • Transducer position
    • Long axis to tendon
  • Needle Approach/ Orientation
    • In plane
    • Obliquely from anterior to posterior
  • Target
    • Popliteus tendon
  • Pearls and Pitfalls
    • Identify and avoid the common peroneal nerve

Aftercare

  • No major restrictions in most cases
  • Can augment with ice, NSAIDS
  • Consider Knee Compression Sleeve to reduce re-accumulation/ swelling

Complications

  • Infection
  • Damage to surrounding tissue

See Also

Internal

References

  1. ↑ Lueders, Daniel R., Jay Smith, and Jacob L. Sellon. "Ultrasound-guided knee procedures." Physical Medicine and Rehabilitation Clinics 27.3 (2016): 631-648.
  2. ↑ 2.0 2.1 Malanga, Gerard A., and Kenneth R. Mautner. "Atlas of ultrasound-guided musculoskeletal injections." (No Title) (2014).
Created by:
John Kiel on 20 February 2025 16:13:39
Authors:
Last edited:
13 March 2025 17:04:58
Category:
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