Abstract
Objective
To examine the efficacy of ultrasound (US)-guided injections for midfoot joint degenerative changes.
Materials and methods
The US images and radiographs of 63 patients with midfoot joint degenerative changes were retrospectively reviewed. In those patients who had US-guided intra-articular steroid injection, the response to the injection was recorded by reviewing the 2-week pain diaries and clinical notes. Partial or complete pain relief was defined as a positive response and the same or increased level of pain as a negative response to the injection.
Results
Fifty-nine (59/63, 93.6%) patients with midfoot joint degenerative changes received US-guided injection. The majority of patients had a positive response up to 3 months post-injection (78.4% still experiencing pain relief at 2 weeks, 57.5% at 3 months and fewer than 15% of patients further than 3 months post-injection). The number of positive therapeutic responses did not differ significantly between patients with diagnostic and non-diagnostic response (p = 0.2636).
Conclusions
US-guided intra-articular injections for midfoot degenerative changes can have a good therapeutic result in the majority of patients up to 3 months post-injection. Therapeutic response cannot be predicted by a positive diagnostic response.
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References
Cheung PP, Dougados M, Gossec L. Reliability of ultrasonography to detect synovitis in rheumatoid arthritis: a systematic literature review of 35 studies (1, 415 patients). Arthritis Care Res (Hoboken). 2010;62:323–34.
Reach JS, Easley ME, Chuckpaiwong B, Nunley JA. Accuracy of ultrasound guided injections in the foot and ankle. Foot Ankle Int. 2009;30:239–42.
Keen HI, Conaghan PG. Ultrasonography in osteoarthritis. Radiol Clin North Am. 2009;47:581–94.
Keen HI, Conaghan PG. Usefulness of ultrasound in osteoarthritis. Rheum Dis Clin North Am. 2009;35:503–19.
Keen HI, Wakefield RJ, Conaghan PG. A systematic review of ultrasonography in osteoarthritis. Ann Rheum Dis. 2009;68:611–9.
Chao J, Kalunian K. Ultrasonography in osteoarthritis: recent advances and prospects for the future. Curr Opin Rheumatol. 2008;20:560–4.
Möller I, Bong D, Naredo E, et al. Ultrasound in the study and monitoring of osteoarthritis. Osteoarthritis Cartilage. 2008;16 Suppl 3:S4–7.
Meenagh G, Filippucci E, Iagnocco A, et al. Ultrasound imaging for the rheumatologist VIII. Ultrasound imaging in osteoarthritis. Clin Exp Rheumatol. 2007;25:172–5.
Chao J, Wu C, Sun B, et al. Inflammatory characteristics on ultrasound predict poorer long-term response to intraarticular corticosteroid injections in knee osteoarthritis. J Rheumatol. 2010;37:650–5.
Ward ST, Williams PL, Purkayastha S. Intra-articular corticosteroid injections in the foot and ankle: a prospective 1-year follow-up investigation. J Foot Ankle Surg. 2008;47:138–44.
Peterson C, Hodler J. Evidence-based radiology (part 2): Is there sufficient research to support the use of therapeutic injections into the peripheral joints? Skeletal Radiol. 2010;39:11–8.
Sun SF, Chou YJ, Hsu CW, et al. Efficacy of intra-articular hyaluronic acid in patients with osteoarthritis of the ankle: a prospective study. Osteoarthritis Cartilage. 2006;14:867–74.
Munteanu SE, Menz HB, Zammit GV, et al. Efficacy of intra-articular hyaluronan (Synvisc) for the treatment of osteoarthritis affecting the first metatarsophalangeal joint of the foot (hallux limitus): study protocol for a randomised placebo-controlled trial. J Foot Ankle Res. 2009;2:2.
Pons M, Alvarez F, Solana J, Viladot R, Varela L. Sodium hyaluronate in the treatment of hallux rigidus: a single-blind, randomized study. Foot Ankle Int. 2007;28:38–42.
Newman JS. Diagnostic and therapeutic injections of the foot and ankle. Semin Roentgenol. 2004;39:85–94.
Middleton F, Coakes J, Umarji S, Palmer S, Venn R, Panayiotou S. The efficacy of intra-articular bupivacaine for relief of pain following arthroscopy of the ankle. J Bone Joint Surg Br. 2006;88:1603–5.
Klint E, Grundtman C, Engstrom M, et al. Intraarticular glucocorticoid treatment reduces inflammation in synovial cell infiltrations more efficiently than in synovial blood vessels. Arthritis Rheum. 2005;52:3880–889.
Lo GH, LaValley M, McAlindon T, Felson DT. Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a meta-analysis. JAMA. 2003;290:3115–21.
Manchikanti L, Hirsch JA, Smith HS. Evidence-based medicine, systematic reviews and guidelines in interventional pain management: Part 2: Randomized controlled trials. Pain Physician. 2008;11:717–73.
Bolton JE. The evidence in evidence-based practice: What counts and what doesn’t count? J Manipulative Physiol Ther. 2001;24:362–6.
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Drakonaki, E.E., Kho, J.S.B., Sharp, R.J. et al. Efficacy of ultrasound-guided steroid injections for pain management of midfoot joint degenerative disease. Skeletal Radiol 40, 1001–1006 (2011). https://doi.org/10.1007/s00256-010-1094-y
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DOI: https://doi.org/10.1007/s00256-010-1094-y