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Skeletal Radiology

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06.05.2019 | Review Article

Pearls and pitfalls of fluoroscopic-guided foot and ankle injections: what the radiologist needs to know

verfasst von: Barry G. Hansford, Megan K. Mills, Christopher J. Hanrahan, Corrie M. Yablon

Erschienen in: Skeletal Radiology | Ausgabe 11/2019

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Abstract

Objective

This article provides a comprehensive, joint-by-joint review of fluoroscopic-guided foot and ankle injections and emphasizes pre-procedural planning, relevant anatomy, appropriate technique, troubleshooting the difficult procedure, and the importance of communicating unexpected findings with the referring clinician. The interrogation of pain generators including variant ossicles, fractures, and post-surgical/traumatic findings is also described.

Conclusions

Even the most challenging foot and ankle injections may be successfully completed with a solid anatomical understanding and thoughtful approach.

Peterson CK, Buck F, Pfirrmann CW, Zanetti M, Hodler J. Fluoroscopically guided diagnostic and therapeutic injections into foot articulations: report of short-term patient responses and comparison of outcomes between various injection sites. AJR Am J Roentgenol. 2011;197:949–53.CrossRef

Rastogi AK, Davis KW, Ross A, Rosas HG. Fundamentals of joint injection. AJR Am J Roentgenol. 2016;207:484–94.CrossRef

Endo Y, Nwawka OK, Smith S, Burket JC. Tarsometatarsal joint communication during fluoroscopy-guided therapeutic joint injections and relationship with patient age and degree osteoarthritis. Skelet Radiol. 2018;47:271–7.CrossRef

Newman JS. Diagnostic and therapeutic injections of the foot and ankle. Semin Roentgenol. 2004;39:85–94.CrossRef

Protheroe D, Gadgil A. Guided intra-articular corticosteroid injections in the midfoot. Foot Ankle Int. 2018;39:1001–4.CrossRef

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.CrossRef

Grice J, Marsland D, Smith G, Calder J. Efficacy of foot and ankle corticosteroid injections. Foot Ankle Int. 2017;38:8–13.CrossRef

Lucas PE, Hurwitz SR, Kaplan PA, Dussault RG, Maurer EJ. Fluoroscopically guided injections into the foot and ankle: localization of the source of pain as a guide to treatment-prospective study. Radiology. 1997;204:411–5.CrossRef

Friedmann DM, Moore ME. The efficacy of intraarticular steroids in osteoarthritis: a double-blinded study. J Rheumatol. 1980;7:850–6.

10.

Peterson C, Hodler J. Evidence-based radiology (part 2): is there sufficient research to support the use of therapeutic injections into the peripheral joints? Skelet Radiol. 2010;39:11–8.CrossRef

11.

Khoury NJ, el-Khoury GY, Saltzman CL, Brandser EA. Intraarticular foot and ankle injections to identify source pain before arthrodesis. AJR Am J Roentgenol. 1996;167:669–73.CrossRef

12.

Mitchell MJ, Bielecki D, Bergman AG, Kursunoglu-Brahme S, Sartoris DJ, Resnick D. Localization of specific joint causing hindfoot pain: value of injecting local anesthetics into individual joints during arthrography. AJR Am J Roentgenol. 1995;164:1473–6.CrossRef

13.

Stegeman M, van Ginneken BT, Boetes B, Tuinhout M, Louwerens JW, Swierstra BA. Can diagnostic injections predict the outcome in foot and ankle arthrodesis? BMC Musculoskelet Disord. 2014;15:1–5.CrossRef

14.

Karasick D, Schweitzer ME. The os trigonum syndrome: imaging features. AJR Am J Roentgenol. 1996;166:125–9.CrossRef

15.

Jones DM, Saltzman CL, El-Khoury G. The diagnosis of the os trigonum syndrome with a fluoroscopically controlled injection of local anesthetic. Iowa Orthop J. 1999;19:122–6.PubMedPubMedCentral

16.

Bianchi S, Bortolotto C, Draghi F. Os peroneum imaging: normal appearance and pathological findings. Insights Imaging. 2017;1:59–68.CrossRef

17.

Sofka CM, Adler RS, Saboerio GR, Pavlov H. Sonographic evaluation and sonographic-guided therapeutic options of lateral ankle pain: peroneal tendon pathology associated with the presence of an os peroneum. HSS J. 2010;2:177–81.CrossRef

18.

Postacchini R, Carbone S, Mastantuono M, Della Rocca C, Postacchini F. Ossification of the interosseous membrane of the leg in a football player: case report and review of the literature. Case Rep Orthop. 2016;2016;2930324. https://doi.org/10.1155/2016/2930324.CrossRef

19.

Hansford BG, Stacy GS. Musculoskeletal aspiration procedures. Semin Interv Radiol. 2012;29:270–85.CrossRef

20.

Piper SL, Kim HT. Comparison of ropivacaine and bupivacaine toxicity in human articular chondrocytes. J Bone Joint Surg Am. 2008;90:986–91.CrossRef

21.

Kamath R, Strichartz C, Rosenthal D. Cartilage toxicity from local anesthetics. Skelet Radiol. 2008;37:871–3.CrossRef

22.

Karpman RR, MacCollum MS III. Arthrography of the metatarsophalangeal joint. Foot Ankle. 1988;9:125–9.CrossRef

23.

Mizel MS, Gutmann JM, Ahn U, Temple HT. Lesser metarsophalangeal joints: intra-articular distension, volumetric measurements, and changes of position. Foot Ankle Int. 2003;24:935–7.CrossRef

24.

Chang CY, Simeone FJ, DeLorenzo MC, Palmer WE, Bredella MA, Huang AJ. Dose reduction for fluoroscopically guided injections: phantom simulation and patient procedures. Skelet Radiol. 2018;47:223–31.CrossRef

25.

Masala S, et al. Diagnostic and therapeutic joint injections. Semin. Interv Radiol. 2010;27:160–71.CrossRef

26.

Lungu E, Moser TP. A practical guide for performing arthrography under fluoroscopic guidance. Insights Imaging. 2015;6:601–10.CrossRef

27.

Lund IM, Donde R, Knudsen EA. Persistent local cutaneous atrophy following corticosteroid injection for tendinitis. Rheumatol Rehabil. 1979;18:91–3.CrossRef

28.

Rogojan C, Hetland ML. Depigmentation: a rare side effect to intra-articular glucocorticoid treatment. Clin Rheumatol. 2004;23:373–5.CrossRef

29.

MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology. 2009;252:647–61.CrossRef

30.

Newberg AH, Munn CS, Robbins AH. Complications of arthrography. Radiology. 1985;155:605–6.CrossRef

31.

Thumboo J, O’Duffy JD. A prospective study of the safety of joint and soft tissue aspirations and injections in patients taking warfarin sodium. Arthritis Rheum. 1998;155:736–9.CrossRef

32.

Breu A, Rosenmeier K, Kujat R, Angele P, Zink W. The cytotoxicity of bupivacaine, ropivacaine, and mepivacaine on human chondrocytes and cartilage. Anesth Analg. 2013;117:514–22.CrossRef

33.

Chu CR, Izzo NJ, Coyle CH, Papas NE, Logar A. The in vitro effects of bupivacaine on articular chondrocytes. J Bone Joint Surg Br. 2008;90:814–20.CrossRef

34.

Fox MG, Patrie JT. Does reducing the concentration of bupivacaine when performing therapeutic shoulder joint injections impact the clinical outcome? AJR Am J Roentgenol. 2016;206:805–9.CrossRef

35.

Berger RG, Yount WJ. Immediate “steroid flare” from intraarticular triamcinolone hexacetonide injection: case report and review of the literature. Arthritis Rheum. 1990;33:1284–6.CrossRef

36.

Habib GS, Bashir M, Jabbour A. Increased blood glucose levels following intra-articular injection of methylprednisolone acetate in patients with controlled diabetes and symptomatic osteoarthritis of the knee. Ann Rheum Dis. 2008;67:1790–1.CrossRef

37.

Draeger RW, Singh B, Parekh SG. Quantifying normal ankle joint volume: an anatomic study. Indian J Orthop. 2009;43:72–5.CrossRef

38.

Standring S. Gray’s anatomy: the anatomical basis of clinical practice. 41st ed. New York: Elsevier; 2016. p. 1339–40.

39.

Kelikian AS. Sarrafian’s anatomy of the foot and ankle: descriptive, topographic, functional. 3rd ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011. p. 550–2.

40.

Manaster BJ. Imaging anatomy. Knee, ankle, foot. 2nd ed. Philadelphia: Elsevier; 2017. p. 438–9.

41.

Crim J. Specialty imaging arthrography: principles and practice in radiology. 1st ed. Altona: Amirsys, Inc; 2009. p. 238–54.

42.

Fox MG, Wright PR, Alford B, Patrie JT, Anderson MW. Lateral mortise approach for therapeutic ankle injection: an alternative to the anteromedial approach. AJR Am J Roentgenol. 2013;200:1096–100.CrossRef

43.

Huang AJ, et al. Radiation dose and intra-articular access: comparison of the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections. Skelet Radiol. 2016;45:367–73.CrossRef

44.

Wright PR, Fox MG, Alford B, Patrie JT, Anderson MW. An alternative injection technique for performing MR ankle arthrography: the lateral mortise approach. Skelet Radiol. 2014;43:27–33.CrossRef

45.

Varenika V, Harter J, Chu E, Steinbach L. The posterolateral approach for fluoroscopy-guided tibiotalar injection. Skelet Radiol. 2017;46:1113–5.CrossRef

46.

Trnka HJ, Ivanic G, Trattnig S. Arthrography of the foot and ankle: ankle and subtalar joint. Foot Ankle Clin. 2000;5:49–62.PubMed

47.

Buck FM, Pfirrmann CW, Brunner F, Hodler J, Peterson C. The posterolateral fluoroscopy-guided injection technique into the posterior subtalar joint: description of the procedure and pilot study on patient outcomes. Skelet Radiol. 2012;41:699–705.CrossRef

48.

Kraus T, Heidari N, Borbas P, Clement H, Grechenig W, Weinberg AM. Accuracy of anterolateral versus posterolateral subtalar injection. Arch Orthop Trauma Surg. 2011;131:759–63.CrossRef

49.

Desai KR, Beltran LS, Becardino JT, Rosenberg ZS, Petchprapa C, Steiner G. The spring ligament recess of the talocalcaneonavicular joint: depiction on MR images with cadaveric and histologic correlation. AJR Am J Roentgenol. 2011;196:1145–50.CrossRef

50.

Hansford BG, Mills MK, Stilwill SE, McGow AK, Hanrahan CJ. Naviculocuneiform and second and third tarsometatarsal articulations: underappreciated normal anatomy and how it may affect fluoroscopy-guided injections. AJR Am J Roentgenol. 2019;212:874–82.CrossRef

51.

Renner K, McAlister JE, Galli MM, Hyer CF. Anatomic description of the naviculocuneiform articulation. J Foot Ankle Surg. 2017;56:19–21.CrossRef

52.

Siddiqui NA, Galizia MS, Almusa E, Omar IM. Evaluation of the tarsometatarsal joint using conventional radiography, CT, and MR imaging. Radiographics. 2014;34:514–31.CrossRef

53.

Preidler KW, Wang YC, Brossman J, Trudell D, Daenen B, Resnick D. Tarsometatarsal joint: anatomic details on MRI images. Radiology. 1996;199:733–73.CrossRef

54.

Borowsky CD, Fagen G. Sources of sacroiliac region pain: insights gained from a study comparing standard intra-articular injection with a technique combining intra- and peri-articular injection. Arch Phys Med Rehabil. 2008;89:2048–56.CrossRef

55.

Luukkainen RK, Wennerstrand PV, Kautiainen HH, Sanila MT, Asikainen EL. Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint. Clin Exp Rheumatol. 2002;20:52–4.PubMed

56.

Nacey NC, Patrie JT, Fox MG. Fluoroscopically guided sacroiliac joint injections: comparison of the effects of intraarticular and periarticular injections on immediate and short-term pain relief. AJR Am J Roentgenol. 2016;207:1055–61.CrossRef

57.

Kershen LM, Nacey NC, Patrie JT, Fox MG. Fluoroscopically guided facet injections: comparison of intra-articular and periarticular steroid and anesthetic injection on immediate and short-term pain relief. AJNR Am J Neuroradiol. 2018;39:2161–5.CrossRef

58.

Kershen LM, Nacey NC, Patrie JT, Fox MG. Accuracy and efficacy of fluoroscopy-guided pars interarticularis injections on immediate and short-term pain relief. Skelet Radiol. 2016;45:1329–35.CrossRef

Titel: Pearls and pitfalls of fluoroscopic-guided foot and ankle injections: what the radiologist needs to know
verfasst von: Barry G. Hansford
Megan K. Mills
Christopher J. Hanrahan
Corrie M. Yablon
Publikationsdatum: 06.05.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Skeletal Radiology / Ausgabe 11/2019
Print ISSN: 0364-2348
Elektronische ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-019-03226-9

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