CT guided diagnostic foot injections

Saifuddin, Asif; Abdus-Samee, M.; Mann, Carolin; Singh, Dishan; Angel, John

doi:10.1016/j.crad.2004.06.017

Cited by 36 publications

(49 citation statements)

References 12 publications

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“…Diagnostic or therapeutic injection procedures into the foot region have been used for many years to help diagnose a particular joint as a pain source or to provide treatment to a painful articulation [1][2][3][4][5][6]. Studies have shown that injections performed using imaging guidance (fluoroscopy, ultrasound, or CT) more accurately deliver the medications to the desired target joint compared to injections using palpation alone [1,[3][4][5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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The posterolateral fluoroscopy-guided injection technique into the posterior subtalar joint: description of the procedure and pilot study on patient outcomes

et al. 2011

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Objective To describe a posterolateral fluoroscopy-guided injection technique into the posterior subtalar joint and to report patient outcomes 1 month post-injection. Materials and methods Twenty-three consecutive adult patients who underwent fluoroscopy-guided injection into the posterior subtalar joint using a direct posterolateral approach and who returned an outcomes-based postal questionnaire after receiving this injection were included. Numerical pain rating scale (NRS) data were collected prior to injection. NRS and Patient's Global Impression of Change (PGIC) scales were completed 1 day, 1 week, and 1 month after injection. The proportion of patients who improved was calculated for each time period. Baseline NRS data were compared to each time point using the Wilcoxon test to assess differences. Spearman's correlation coefficient was used to compare the 20 min NRS score with all follow-up NRS scores. All available images were reviewed for the presence of subtalar osteoarthritis (OA). Patient charts were reviewed to identify characteristics of patients referred for subtalar injections. Risk ratios were calculated comparing presence of OA or other abnormalities with improvement. Results A posterolateral approach for fluoroscopy-guided injections into the subtalar joint is described. There was a significant reduction in the mean NRS score at all time periods compared to baseline (p ≤ 0.004). One-third of patients (7/21) reported clinically relevant improvement at 1 month. Conclusions Fluoroscopy-guided puncture of the posterior subtalar joint using a posterolateral approach is possible. Clinically significant improvement is reported in 33% of patients after 1 month.

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Section: Introductionmentioning

confidence: 99%

“…Studies have shown that injections performed using imaging guidance (fluoroscopy, ultrasound, or CT) more accurately deliver the medications to the desired target joint compared to injections using palpation alone [1,[3][4][5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

The posterolateral fluoroscopy-guided injection technique into the posterior subtalar joint: description of the procedure and pilot study on patient outcomes

et al. 2011

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“…Unfortunately, no radiation dose was mentioned in any of the publication regarding fluoroscopically or CT-guided foot infiltration [2,6,13]. Therefore, a comparison is not possible.…”

Section: Discussionmentioning

confidence: 99%

“…Saifuddin et al reported technically successful foot and ankle intervention in 28 cases. Here, CT-guidance proved to be of special value for patients with post-traumatic, disordered anatomy and presence of osteophytes after failure of conventional fluoroscopically guided infiltrations [6]. Wiewiorski and al.…”

Section: Discussionmentioning

confidence: 99%

“…In the foot, infiltrations are often difficult due to the complex anatomy with small, tightly neighbouring joints [5]. In degenerative joint conditions, the accuracy is additionally often compromised by the presence of osteophytes and unusual post-traumatic or post-operatively disordered anatomy [6]. The radiation exposure that comes along with the fluoroscopical guidance should not be underestimated and relies on the experience of the performer [7].…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous foot joint needle placement using a C-arm flat-panel detector CT

et al. 2011

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Purpose Image guidance is valuable for diagnostic injections in foot orthopaedics. Flat-detector computed tomography (FD-CT) was implemented using a C-arm, and the system was tested for needle guidance in foot joint injections. Methods FD-CT-guided joint infiltration was performed in 6 patients referred from the orthopaedic department for diagnostic foot injections. All interventions were performed utilising a flat-panel fluoroscopy system utilising specialised image guidance and planning software. Successful infiltration was defined by localisation of contrast media depot in the targeted joint. The pre-and post-interventional numeric analogue scale (NAS) pain score was assessed. Results All injections were technically successful. Contrast media deposit was documented in all targeted joints. Significant relief of symptoms was noted by all 6 participants. Conclusions FD-CT-guided joint infiltration is a feasible method for diagnostic infiltration of midfoot and hindfoot joints. The FD-CT approach may become an alternative to commonly used 2D-fluoroscopically guidance.

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A randomized, double‐blind, controlled study of ultrasound‐guided corticosteroid injection into the joint of patients with inflammatory arthritis

Cunnington¹,

Marshall²,

Hide³

et al. 2010

Arthritis & Rheumatism

211

141

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Objective. Most corticosteroid injections into the joint are guided by the clinical examination (CE), but up to 70% are inaccurately placed, which may contribute to an inadequate response. The aim of this study was to investigate whether ultrasound (US) guidance improves the accuracy and clinical outcome of joint injections as compared with CE guidance in patients with inflammatory arthritis.Methods. A total of 184 patients with inflammatory arthritis and an inflamed joint (shoulder, elbow, wrist, knee, or ankle) were randomized to receive either US-guided or CE-guided corticosteroid injections. Visual analog scales (VAS) for assessment of function, pain, and stiffness of the target joint, a modified Health Assessment Questionnaire, and the EuroQol 5-domain questionnaire were obtained at baseline and at 2 weeks and 6 weeks postinjection. The erythrocyte sedimentation rate and C-reactive protein level were measured at baseline and 2 weeks. Contrast injected with the steroid was used to assess the accuracy of the joint injection.Results. One-third of CE-guided injections were inaccurate. US-guided injections performed by a trainee rheumatologist were more accurate than the CE-guided injections performed by more senior rheumatologists (83% versus 66%; P ‫؍‬ 0.010). There was no significant difference in clinical outcome between the group receiving US-guided injections and the group receiving CEguided injections. Accurate injections led to greater improvement in joint function, as determined by VAS scores, at 6 weeks, as compared with inaccurate injections (30.6 mm versus 21.2 mm; P ‫؍‬ 0.030). Clinicians who used US guidance reliably assessed the accuracy of joint injection (P < 0.001), whereas those who used CE guidance did not (P ‫؍‬ 0.29).Conclusion. US guidance significantly improves the accuracy of joint injection, allowing a trainee to rapidly achieve higher accuracy than more experienced rheumatologists. US guidance did not improve the short-term outcome of joint injection.

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CT guided diagnostic foot injections

Cited by 36 publications

References 12 publications

The posterolateral fluoroscopy-guided injection technique into the posterior subtalar joint: description of the procedure and pilot study on patient outcomes

The posterolateral fluoroscopy-guided injection technique into the posterior subtalar joint: description of the procedure and pilot study on patient outcomes

Percutaneous foot joint needle placement using a C-arm flat-panel detector CT

A randomized, double‐blind, controlled study of ultrasound‐guided corticosteroid injection into the joint of patients with inflammatory arthritis

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