A systematic review of injectable corticosteroid for osteoarthritis of the first metatarsophalangeal joint&amp;nbsp;

Reilly, Ian; Bromley, Gillian; Flanagan, George

doi:10.21203/rs.3.rs-105785/v1

Cited by 6 publications

(7 citation statements)

References 33 publications

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“…The final count of papers utilised for review was 37. Iterative charting of the literature yielded three broad and overlapping themes: Nineteen articles are summarised Themes 1 and 2 (two articles appear in Theme 2 also) with a systematic review of the result of further work [69]. 20 articles (plus one, one unreferenced, and one found after the initial search) were technical/technique articles (Theme 2) and led to the development of a best practice IT guideline [100].…”

Section: Resultsmentioning

confidence: 99%

Hit and miss: The accuracy of intra-articular injections of the first metatarsophalangeal joint

Reilly

2022

J Int Foot Ankle

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Introduction: Therapeutic injections provide a treatment option for patients with joint and periarticular pain, those who are not surgical candidates, whom conservative treatment has failed, or those that are awaiting surgery. Injectable glucocorticoids are one of the most common therapeutic interventions in musculoskeletal healthcare and are widely used in pathologies of the first metatarsophalangeal joint. The aim of this paper is to highlight current concepts around first metatarsophalangeal joint injection injection accuracy. Anatomy: The first metatarsophalangeal joint is a condyloid synovial juncture and consists of the head of the first metatarsal, the base of the proximal phalanx, six muscles, eight ligaments and two sesamoid bones, with associated ligamentous attachments. The joint capsule is shaped like a box. Methods: To achieve the research aim, a scoping review was undertaken with a search strategy that identified evidence via the following sources: Electronic databases, Google scholar, and Reference lists. Results: The search yielded 193 articles, 48 of which appeared of potential relevance. After removing duplicate articles this total was reduced to 37 articles. After scanning the content, 27 were excluded to leave 10 articles. Twenty eight further articles were found through related author research, examination of reference lists and free text searches of Google Scholar. One reference was unobtainable. The final count of papers utilised for review was 37 which produced three themes, one of which was injection accuracy. Injection accuracy: In the long history of injection therapy, infiltrations have often been performed without image guidance, i.e., using palpation guidance, anatomical landmarks and clinical judgement to direct needle entry and advancement. Needle placement may also be confirmed by use of diagnostic imaging. Typical imaging modalities are fluoroscopy or ultrasound, used alone or in combination with contrast media. Discussion: The perceived wisdom is that if an injectate misses its target it is likely to be less effective and lead to false negative reporting of poor treatment outcomes, but the literature is not equivocal. This article discusses the recent literature in the field. Conclusions: The literature suggests that steroid injections are safe and effective for the short-term relief of joint pain. When injecting small synovial joints using palpated-guided methods, clinicians must be alert to the potential for failure of technique from the needle penetrating too far into the articulation and exiting the joint on the contralateral side from the entry point. Use of shorter needles and use of imaging, +/- the use of contrast media, might reduce the number of such failures.

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Section: Resultsmentioning

confidence: 99%

Hit and miss: The accuracy of intra-articular injections of the first metatarsophalangeal joint

Reilly

2022

J Int Foot Ankle

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“…Reilly et al 70 performed a systematic review to determine if good quality research exists to enable clinicians to adopt an evidence-based approach to 1 st MTP jt CSIs for OA. Despite the frequency of use, the review found no high-quality studies that support their use.…”

Section: Post-operative Arthrofibrosismentioning

confidence: 99%

Use of Intra-Articular Injection Corticosteroid Injections to the First Metatarsophalangeal Joint. First Theme of a Scoping Review

Reilly¹,

Botchu²

2022

Preprint

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Introduction. A needle is inserted into a joint for arthrocentesis or injection of a therapeutic medication(s), commonly a corticosteroid. The aim of this paper is to discuss the first theme identified from a scoping review of corticosteroid injections for the pathology of the first metatarsophalangeal joint. Pathology. The two most common pathologies affecting the first metatarsophalangeal joint are osteoarthritis and bunions. An arthritic joint is regularly injected with a corticosteroid, but bunions are not. Other pathologies that may receive an injection include rheumatoid arthritis, gout, sesamoiditis and post-operative arthrofibrosis. Discussion. Most available evidence discusses corticosteroid injections for osteoarthritis, but there is a paucity of high-quality evidence, especially for corticosteroid use in other pathological conditions. Conclusion. Whilst the evidence base suggests that corticosteroid injections are safe short- and mid-term treatment options for a range of soft tissue and joint pathology, the specific indications, and short/long-term outcomes in the first metatarsophalangeal joint pathologies are not clear and warrant further study.

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“…Reilly et al (2020) performed a systematic review of injectable corticosteroid for OA of the 1 st MTP jt (Reilly at al, 2020). The aim of their review was to determine if good quality research exists to enable clinicians to adopt an evidenced based approach to corticosteroid injection (CSI) of the jt.…”

Section: Pathologymentioning

confidence: 99%

“…With the review by Reilly et al (2020) failing to produce strong evidence for the IA CSI of 1 st MTP jt OA, a scoping review was therefore considered to be the most suitable approach to answer the research question looking at the wider themes about injection therapy of this jt. (Levac et al, 2010).…”

Section: Munn Et Al (Munn Et Al 2018) Listed the Indications For Scoping Reviewsmentioning

confidence: 99%

Key concepts for intra-articular corticosteroid injections for pathology of the first metatarsophalangeal joint: a scoping review protocol

Reilly¹

2021

Preprint

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Background: The two most common diseases affecting the first metatarso-phalangeal joint (1st MTP jt) of the foot are hallux limitus/rigidus (osteoarthritis) and hallux valgus (bunion), but other pathologies also affect the region. There are a range of treatments for these conditions: one treatment option is intra articular injection therapy, and this is one of the most common therapeutic interventions in musculoskeletal healthcare. Therapeutic injections of corticosteroids provide a treatment option for patients with joint or peri-articular pain, those who are not surgical candidates, in those in whom conservative treatment has failed or for those awaiting surgery. They are accepted as an important treatment modality, but currently there are no evidenced-based guidelines about administration technique or regimen of the 1st MTP jt. This is a scoping review protocol for the study to identify key concepts in intra-articular corticosteroid injections for pathology of the first metatarsophalangeal joint.Methods and analysis: Scoping reviews are used to assess and understand the extent of the knowledge in an emerging field or to identify, map, report, or discuss the characteristics or concepts in that field. The Joanna Briggs Institute (JBI) is an international research organisation based in the Faculty of Health and Medical Sciences at the University of Adelaide. The JBI develops and delivers evidence-based information, software, education, and training and its guidance is widely cited across a range of disciplines, academic fields, and professional backgrounds. This scoping review will follow the JBI process who recommend the PCC framework (‘Population–Concept–Context’) to frame the research question. The ‘Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews’ will be used to guide the reporting of this protocol and will also subsequently be used to structure the reporting of the full review (PRISMA-ScR). Dissemination: Findings will be presented to explore speciality-specific and profession-specific commonalities and differences. The scoping review results will be disseminated via publication in peer-reviewed journals (it is envisaged that at least two publications will be developed) and presentation at national/international conferences.

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A systematic review of injectable corticosteroid for osteoarthritis of the first metatarsophalangeal joint

Cited by 6 publications

References 33 publications

Hit and miss: The accuracy of intra-articular injections of the first metatarsophalangeal joint

Hit and miss: The accuracy of intra-articular injections of the first metatarsophalangeal joint

Use of Intra-Articular Injection Corticosteroid Injections to the First Metatarsophalangeal Joint. First Theme of a Scoping Review

Key concepts for intra-articular corticosteroid injections for pathology of the first metatarsophalangeal joint: a scoping review protocol

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