The symptoms of joint inflammation can be markedly improved with an injection of a steroid into the joint. Because repeated steroid injections can have a negative long-term effect on the joint, potential candidates are carefully selected.

References

AJR Am J Roentgenol. 1996 Sep;167(3):669-73.

Intraarticular foot and ankle injections to identify source of pain before arthrodesis.

Khoury NJ, el-Khoury GY, Saltzman CL, Brandser EA.

Department of Radiology, University of Iowa College of Medicine, Iowa City 52242, USA.

OBJECTIVE: The purpose of our study was to evaluate the usefulness of diagnostic joint injections in patients with foot and ankle pain when the radiologist attempts to identify the source of pain. This study also correlated the results of injection with outcome after arthrodesis.

MATERIAL AND METHODS: We retrospectively reviewed the records of 22 patients who had a foot or ankle joint injected to identify a source of pain and who later underwent arthrodesis of the painful joint. All patients had long-term foot and ankle symptoms of variable causes. Twenty-four joints were assessed: 13 subtalar, five talonavicular, four ankle, one calcaneocuboid, and one metatarsocuneiform. All patients had plain radiographs, 11 had CT studies, and five had bone scans. Contrast material was used to assess adequate positioning of the needle inside the joint before injection. All joints were injected under fluoroscopic control. Steroid was added in eight joints. After injection, patients were assessed for relief of symptoms. Patients subsequently underwent arthrodesis on the basis of the results of the injection.

RESULTS: In 20 patients (22 joints), long-term follow-up showed that injections allowed us to correctly identify the source of pain and successfully guide arthrodesis. Of these 20 patients, 17 had significant pain relief after injection and fusion, whereas three patients had mild or no response. With one of these patients, we injected other joints and changed surgical plans. One of the two remaining patients had more pain relief after injection than after arthrodesis. The other patient had no relief after injection, but subsequent fusion because of persistent pain was successful. We found imaging studies to be less useful than diagnostic injections when we were attempting to identify the source of pain.

CONCLUSION: Intraarticular injection of anesthetic in painful foot and ankle joints helped us confirm the source of pain in 20 of 22 patients, which in turn led to successful arthrodesis and good outcomes for these patients.

Iowa Orthop J. 1999;19:122-6.

The diagnosis of the os trigonum syndrome with a fluoroscopically controlled injection of local anesthetic.

Jones DM, Saltzman CL, El-Khoury G.

University of Iowa, Department of Orthopaedic Surgery, Iowa City, USA. Darron-Jones@uiowa.edu

PURPOSE: To report the results of excision of the os trigonum using a fluoroscopically controlled injection of local anesthetic to diagnose the os trigonum syndrome.

DESIGN AND PATIENTS: Os trigonum syndrome is a recognized cause of pain in the posterior aspect of the foot and ankle. The symptoms and physical findings, however, are often nonspecific and difficult to differentiate from other causes of posterior ankle pain. We report four patients with persistent posterolateral ankle pain despite prolonged nonoperative treatment. An os trigonal syndrome was diagnosed by a positive response to a fluoroscopically guided local anesthetic injection in the region of synchondrosis between the os trigonum and the posterior talus.

RESULTS: All four patients underwent excision of the os trigonum with complete resolution of symptoms and return to full activity.

CONCLUSIONS: Fluoroscopically controlled injection can help confirm the suspected diagnosis of an os trigonum syndrome and may have positive predictive value regarding the outcome of excisional surgery