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Open Access 01-12-2014 | Research article

Can diagnostic injections predict the outcome in foot and ankle arthrodesis?

Authors: Mark Stegeman, Berbke To Josephine van Ginneken, Bastiaan Boetes, Mirjam Tuinhout, Jan Willem Karel Louwerens, Bartele Alexander Swierstra

Published in: BMC Musculoskeletal Disorders | Issue 1/2014

Abstract

Background

Intra-articular anesthetic drug injections are claimed to confirm the localization of the pain in order to treat the pain. The aim of the present study was to evaluate whether a positive effect of injection could be indicative for a successful outcome of future arthrodesis.

Methods

74 Patients underwent fluoroscopically guided and contrast confirmed anesthetic joint injections for diagnostic reasons. Before and after injection, pain was measured by use of the Visual Analogue Scale (VAS) in rest and after exercise. Pain reduction was expressed as delta VAS (dVAS). Also, the Foot Function Index (FFI) was obtained. Based on the effect of the diagnostic injection and various clinical factors, patients were advised a conservative treatment (conservative group, n = 34) or an arthrodesis of the affected joint (operative group, n = 40). After a median follow-up period of 3.6 years (range 2.1 to 4.3 years) patients were again invited to complete the FFI and VAS in rest and after exercise. For data-analysis purposes the patients were assigned to four different groups, based on the result of injection and the occurrence of surgery. Wilcoxon signed rank tests and Mann Whitney U tests were used for statistical analysis.

Results

Based on the analysis of the four groups we found that surgery, irrespective of the presence of pain reduction after injection, was related to improvement of VAS and FFI. Patients with conservative treatment always showed worse VAS and FFI scores, even when previous injections showed an improvement of VAS.

Conclusions

Fluoroscopically-guided anesthetic injections of the supposed painful foot-ankle joint seem not to be indicative for a successful outcome of an arthrodesis of the affected joint. However, the sole occurrence of surgery shows a significant difference in VAS and FFI scores, where conservative treatment does not. The local hospital review board granted permission for this study. Ethical approval was not required for this study.

Chow S, Brandser E: Diagnostic and therapeutic foot and ankle injections. Seminars Musculoskelet Radiol. 1998, 2: 421-432. 10.1055/s-2008-1080122.CrossRef

Khoury NJ, El-Khoury GY, Saltzman CL, Brandser EA: Intraarticular foot and ankle injections to identify source of pain before arthrodesis. Am J Roentgenol. 1996, 167: 669-673. 10.2214/ajr.167.3.8751679.CrossRef

Mitchell MJ, Bielecki D, Bergman AG, Kursunoglu-Brahme S, Sartoris DJ, Resnick D: Localization of specific joint causing hindfoot pain: value of injecting local anesthetics into individual joints during arthrography. Am J Roentgenol. 1995, 164: 1473-1476. 10.2214/ajr.164.6.7754895.CrossRef

Ruhoy MK, Newberg AH, Yodlowski ML, Mizel MS, Trepman E: Subtalar joint arthrography. Semin Musculoskelet Radiol. 1998, 2: 433-438. 10.1055/s-2008-1080123.CrossRefPubMed

Saifuddin A, Abdus-Samee M, Mann C, Singh D, Angel JC: CT guided diagnostic foot injections. Clin Radiol. 2005, 60: 191-195. 10.1016/j.crad.2004.06.017.CrossRefPubMed

Atasoy E: Thoracic outlet compression syndrome. Orthop Clin North Am. 1996, 27: 265-303.PubMed

Bell SJ, Hofmeister EP, Moran SL, Shin AY: The diagnostic utility of midcarpal anesthetic injections in the evaluation of chronic wrist pain. Hand. 2007, 2: 39-45. 10.1007/s11552-006-9014-2.CrossRefPubMedPubMedCentral

Neer CS, Welsh RP: The shoulder in sports. Orthop Clin North Am. 1977, 8: 583-591.PubMed

Schon LC: Nerve entrapment, neuropathy, and nerve dysfunction in athletes. Orthop Clin North Am. 1994, 25: 47-59.PubMed

10.

Bryant D, Havey TC, Roberts R, Guyatt G: How many patients? How many limbs? Analysis of patients or limbs in the orthopedic literature: a systematic review. J Bone Joint Surg Am. 2006, 88: 41-45.CrossRefPubMed

11.

Resnick D: Arthrography, tenography and bursography. Diagnosis of Bone and Joint Disorders, Volume 4. 2002, Philadelphia: Saunders, 290-304. 1

12.

DeLoach LJ, Higgins MS, Caplan AB, Stiff JL: The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale. Anesth Analg. 1998, 86: 102-106.PubMed

13.

Agel J, Beskin JL, Brage M, Guyton GP, Kadel NJ, Saltzman CL, Sands AK, Sangeorzan BJ, Sookoo NF, Stroud CC, Thordarson DB: Reliability of the foot function index: a report of the AOFAS outcome committee. Foot Ankle Int. 2005, 26 (11): 962-967.PubMed

14.

Budiman-Mak E, Conrad KJ, Roach KE: The foot function index: a measure of foot pain and disability. J Clin Epidemiol. 1991, 44: 561-570. 10.1016/0895-4356(91)90220-4.CrossRefPubMed

15.

Kuyvenhoven MM, Gorter KJ, Zuithoff P: The foot function index with verbal rating scales (FFI-5 pt): a clinimetric evaluation and comparison with the original FFI. J Rheumatology. 2002, 29: 1023-1028.

16.

Crawford RW, Gie GA, Ling RS, Murray DW: Diagnostic value of intra-articular anaesthetic in primary osteoarthritis of the hip. J Bone Joint Surg Br. 1998, 80: 279-281. 10.1302/0301-620X.80B2.8299.CrossRefPubMed

17.

Carmont MR: Variability of joint communications in the foot and ankle demonstrated by contrast enhanced diagnostic injections. Foot Ankle Int. 2009, 30: 439-442. 10.3113/FAI.2009.0439.CrossRefPubMed

18.

Lucas PE, Hurwitz SR, Kaplan PA, Dussault RG, Maurer EJ: Fluoroscopically guided injections into the foot and ankle: localization of the source of pain as a guide to treatment–prospective study. Radiology. 1997, 204: 411-415.CrossRefPubMed

19.

Newman JS: Diagnostic and therapeutic injections of the foot and ankle. Semin Roentgenol. 2004, 39: 85-94. 10.1016/j.ro.2003.10.008.CrossRefPubMed

20.

Jacobson JA: Detection of ankle effusions: comparison study in cadavers using radiography, sonography, and MR imaging. Am J Roentgenol. 1998, 171: 1231-1238.CrossRef

21.

Khosla S, Thiele R, Baumhauer JF: Ultrasound guidance for intra-articular injections of the foot and ankle. Foot Ankle Int. 2009, 30 (9): 886-890. 10.3113/FAI.2009.0886. 10CrossRefPubMed

22.

Reach JS, Easley ME, Chuckpaiwong B, Nunley JA: Accuracy of ultrasound guided injections in the foot and ankle. Foot Ankle Int. 2009, 30: 239-242. 10.3113/FAI.2009.0239.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/15/11/prepub

Title: Can diagnostic injections predict the outcome in foot and ankle arthrodesis?
Authors: Mark Stegeman
Berbke To Josephine van Ginneken
Bastiaan Boetes
Mirjam Tuinhout
Jan Willem Karel Louwerens
Bartele Alexander Swierstra
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2014
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/1471-2474-15-11

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Can diagnostic injections predict the outcome in foot and ankle arthrodesis?

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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