Effect of Lateral Ankle Joint Anesthesia on Center of Balance, Postural Sway, and Joint Position Sense

Abstract

The purpose of this study was to investigate the effects of induced anesthesia of the lateral ankle joint on proprioception as assessed in weight-bearing and non-weight-bearing conditions. Sixteen subjects were assessed under normal conditions and following an 8-cc injection of lidocaine into the anterior talofibular ligament of the ankle being tested. Center of balance and postural sway measurements were analyzed, revealing a significant lateral adjustment of center of balance during the stable tests compared to a medial adjustment during the dynamic tests under the anesthetized condition. ANOVA of postural sway scores revealed no main effect for condition (anesthesia vs. no anesthesia), but sway scores were higher during the two dynamic conditions as compared to the stable condition. ANOVA of joint position error scores revealed no main effect for condition. Findings suggest that inhibition of the joint receptor afferent fibers adversely affected joint proprioception as assessed while subjects were weight bearing but not while they were non-weight bearing.

The Effect of Reduced Somatosensation on Standing Balance: A Systematic Review

“…Other measurements used were touch pressure sensation threshold, 19,26,36,47 two-point discrimination, pressure algometry, 5 joint motion perception threshold, 19 and active and passive joint position sense. 19,32,35 Also, more extensive somatosensation measurements were taken, like the Valk score 25,26,36 and the neurological disability score (NDS). 34,41,42 This spectrum of somatosensation measurements complicates the presentation of an overall conclusion.…”

“…19 In healthy subjects who received an anesthetic injection at the lateral aspect of the ankle, passive joint position sense was not affected. 32 In contrast, when a tourniquet was applied just above the ankle, inducing a local anesthesia from prolonged ischemia, passive joint position sense was reduced. 35 However, active joint position sense was not affected.…”

“…5 Tactile sensation in healthy subjects was impaired when the feet were hypothermically anesthetized. This was only measured in one article, 5 the other two studies 32,35 in healthy subjects only measured proprioceptive sensation. This means that only a preliminary conclusion can be drawn about decreased tactile sensation caused by hypothermically anesthetising the plantar surface of the feet of healthy subjects.…”

“…19,32,35 One study was in patients with DN, 19 and the other two studies were about experimentally reduced somatosensation in healthy subjects. 32,35 Patients with DN had significantly increased passive joint motion perception threshold compared to the controls. 19 In healthy subjects who received an anesthetic injection at the lateral aspect of the ankle, passive joint position sense was not affected.…”

Contralateral force sense deficits are related to the presence of functional ankle instability

“…13 Physiologically, it is unclear which structures control the ability to reproduce joint angles. Joint receptors were originally thought to play a primary role in joint position, 5,38,39 but it has also been shown that muscle spindles contribute to this sensation. 5 Because muscle spindles monitor change in length and the rate in change of length of the muscle, the ability to accurately reproduce a joint angle could be related to spindle function.…”