OK, so we're just going to continue our journey CAUDAD, and we're going to talk about the talocrural joint injection. Maybe I will get a little more gel here. So as I mentioned in my lecture, this is actually one of my favorite injections because it shouldn't be hard, and it's not very uncomfortable to the patient. And so here we see the talocrural joint on long axis, OK? And so to the left of the screen is our tibia. To the right of the screen is the talus. You can see the articular cartilage of the talus there. And you can see with my hand here, I'm just going to put this needle in right here and move it. And there it is. And you can see that this is a very difficult injection to get down into the talocrural joint to the left of the screen with this angle. You really need to do a big standoff. And again, you don't really see the anterior tibial artery and you don't see the deep peroneal nerve. So as I mentioned before, I like to go short axis on this. So again, to the left of the screen is going to be lateral. To the right of the screen is going to be medial. So we see the anterior tibialis tendon. We see the tendon of the flexor or extensor hallucis longus. And I like to see the articular cartilage in this view. So if I'm going a little bit too distal, I'm off the articular cartilage. And now, you know, I'm getting on the tibia. So I want to see the articular cartilage. And so again, we're going to go medial to lateral. Sometimes there's a big vein there medially. So just be aware of that before you enter. So, what I'm going to do is angle my needle posteriorly. And in live patients, the dictum we have is that we never advance the needle until we see the tip of the needle. So, we put it under the skin and we find it. Usually with cadavers, we violate that sometimes. But in real life, and when I'm teaching this, over and over and over again, we say never advance the needle until you see the tip of it. And so right now, I'm probably a little bit distal because I'm getting off the articular cartilage. So, again, this has come up many times this afternoon. So what do I do? I adjust the needle, adjust the probe. So I'm going to just translate the probe a little bit proximally. That's where I want to be. So that means I'm going to back the needle out and then adjust it a little bit more proximally. And now I'm exactly where I want to be. So now I'm just going to float very gently on top of that articular cartilage. If you poke that articular cartilage, the patient's not going to like you. I'm going to just kind of just float or land right on top of it. The bevel is pointing down. And then that's how I inject. And what I should see is just the injectate just disappear within the joint. Okay, then I'm just going to quick show you the image you'll get. And then if you want to challenge yourself, you can do it. But this is the image we're going to get for a subtalar joint injection. So as I mentioned, it's going to be 45 degrees to the coronal and the axial plane. And so to the left of the screen is going to be the calcaneus. You can see the peroneal tendons with anisotropy. And to the right of the screen is going to be the talus. And you can see that little hypochord gap, that is the subtalar joint. So what I would do, I would center it, get it right in the center of the screen, start in the center of the screen, and walk down my needle. I would start and walk down my needle and get it right into that. So if you want to leave here with a challenge, then this would be a good challenge for you. OK.

talocrural joint injection

placement of the needle

anterior tibial artery

deep peroneal nerve

subtalar joint injection