Ultrasound-guided steroid tendon sheath injections in juvenile idiopathic arthritis: a 10-year single-center retrospective study

Abstract

BackgroundThe aims of this study were to: (a) Identify tendon sheaths most commonly treated with steroid injections in a pediatric patient population with Juvenile Idiopathic Arthritis (JIA); (b) Describe technical aspects of the procedure; (c) Characterize sonographic appearance of tenosynovitis in JIA; (d) Assess agreement between clinical request and sites injected.MethodsThis was a 10 year single-center retrospective study (May 2006-April 2016) of patients with JIA referred by Rheumatology for ultrasound-guided tendon sheath injections. Patient demographics, clinical referral information, sonographic appearance of the tendon sheaths and technical aspects of the procedure were analyzed.ResultsThere were 308 procedures of 244 patients (75% female, mean age 9.6 years) who underwent a total of 926 tendon sheath injections. Ankle tendons were most commonly injected (84.9%), specifically the tendon sheaths of tibialis posterior (22.3%), peroneus longus (20%) and brevis (19.7%). The majority of treated sites (91.9%) showed peritendinous fluid and sheath thickening on ultrasound. There were 2 minor intra-procedure complications without sequelae. A good agreement between clinical request and sites injected was observed.ConclusionsUltrasound-guided tendon sheath injections with steroids are used frequently to treat patients with JIA. It is a safe intervention with a high technical success rate. The ankle region, specifically the medial compartment, is the site most commonly injected in this group of patients. The most common sonographic finding is peritendinous fluid and sheath thickening. These findings might assist clinicians and radiologists to characterize and more effectively manage tenosynovitis in patients with JIA.

Comparison Between Clinical and Ultrasound Assessment of the Ankle Region in Children With Juvenile Idiopathic Arthritis

“…We included examination of the ATC in our US procedures and in our data analysis, but we found that tenosynovitis was less frequent in this compartment than in the MTC and LTC. This finding is in keeping with the notion that the use of US to guide tendon sheath injections in JIA is more common in the MTC and LTC of the ankle (31). The observation that the clinician did not report involvement of the ATC in any ankles in our patients may be explained, at least in part, by considering the fact that tenosynovitis affecting the ATC may easily mimic the presence of synovitis in the anterior joint structures of the ankle, particularly in the TT joint and IT joint, since this tendon compartment runs superficially above the anterior surface of the ankle region.…”

Treatment of Achilles Tendinopathy in Recreational Runners with Peritendinous Hyaluronic Acid Injections: A Viscoelastometric, Functional, and Biochemical Pilot Study

“…A 1.5-inch needle was visualized in the long axis of the transducer and, with US control, was advanced. Once the needle tip was seen within the peritendinous effusion, the effusion was aspirated and collected for further analysis as described in Wu et al [ 24 ], Chiodo et al [ 25 ], and Peters et al [ 26 ]. HA was injected into the peritendinous area using real-time US monitoring (T0).…”

What’s new in musculoskeletal ultrasound in pediatric rheumatology?

“…This technique offers greater clinical efficacy by ensuring the correct injection of the therapeutic substance and thus reducing the risk of complications. In clinical practice, the most commonly injected tendon sheaths seem to be the tibialis posterior, peroneus longus and peroneus brevis, as reported in a recent observational study [48]. No major complications were observed [48].…”

“…MSUS in monitoring the disease activity and response to treatment MSUS imaging can also play a key role in guiding steroid injections into joints, tendon sheathsand even tendon insertions (entheses) [46][47][48]. Local corticosteroid (preferably triamcinolone hexacetonide) injections are a common treatment for young patients with JIA, well tolerated and effective for several months, used particularly in the oligoarthritis subset of JIA.…”