Superior Tibiofibular Joint Injection

Acute or chronic capsulitis

Causes and findings:
• Usually trauma such as a fall with forced medial rotation and varus on a flexed knee
• Pain over lateral side of knee
• Painful: resisted flexion of knee full passive medial rotation of knee

Equipment:
Syringe - 2ml
Needle - 23G 1 inches (25mm) blue
Kenalog 40 - 20 mg
Lidocaine - 1 ml 2%
Total volume - 1.5 ml

Anatomy:
The superior tibiofibular joint line runs medially from superior to inferior. The anterior approach is safer as the peroneal nerve lies posterior to the joint.

Technique:
• Patient sits with knee at right angle
• Identify head of fibula and mark joint line medial to it
• Insert needle at mid-point of joint line and aim obliquely laterally to penetrate capsule
• Deposit solution in bolus

Aftercare:
Advise relative rest for at least 1 week and then resumption of normal activities. Strengthening of the biceps femoris might be necessary.

Comments:
Occasionally the joint is subluxed and has to be manipulated before infiltration. The condition also occasionally occurs after severe ankle sprain.

Alternative approach:
The unstable joint can be treated with sclerotherapy.