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Ghandour S, Taseh A, Sussman W, Guss D, Ashkani-Esfahani S, Gupta A, Waryasz G. Case Report: Portable handheld ultrasound facilitates intra-articular injections in articular foot pathologies. FRONTIERS IN PAIN RESEARCH 2024; 5:1254216. [PMID: 38486871 PMCID: PMC10937340 DOI: 10.3389/fpain.2024.1254216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Background Intra-articular injections are commonly used to manage joint pathologies, including osteoarthritis. While conventional ultrasound (US) guidance has generally improved intra-articular injection accuracy, forefoot and midfoot joint interventions are still often performed without imaging guidance. This pilot study aims to evaluate the efficacy of office-based, portable ultrasound (P-US) guided intra-articular injections for forefoot and midfoot joint pain caused by various degenerative pathologies. Methods A retrospective analysis was conducted on a series of consecutive patients who underwent P-US guided intra-articular injections following a chief complaint of forefoot or midfoot joint pain. Patients reported their pain levels using the Visual Analog Scale (VAS) pre-injection and at 3 months follow-up. The procedure was performed by an experienced foot and ankle surgeon using a linear array transducer for guidance, and a 25-gauge needle was used to inject a combination of 2 cc 1% lidocaine and 12 cc of Kenalog (40 mg/ml). Complications and pain scores were analyzed using a paired t-test and p < 0.05 was considered significant. Results We included 16 patients, 31% male and 69% female with a mean age (±SD) of 61.31 (±12.04) years. None of the patients experienced immediate complications following the intervention. The mean pre-injection VAS score was significantly reduced from 5.21 (±2.04) to a mean of 0.50 (±1.32) at 3 months follow-up (P < 0.001). Thirteen patients reported complete resolution of pain at the 3-month follow-up. No adverse events were reported throughout the duration of the study. Conclusion This pilot study suggests P-US-guided intra-articular injections offer a safe and effective method for managing forefoot and midfoot joint pain caused by various arthritic pathologies. Further research is warranted to establish the long-term efficacy and comparative effectiveness of P-US-guided injections in larger patient cohorts as compared to non-image guided injections.
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Affiliation(s)
- Samir Ghandour
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Atta Taseh
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Walter Sussman
- Good Samaritan Medical Center, Boston Sports & Biologics PC, Wellesley, MA, United States
| | - Daniel Guss
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ashim Gupta
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX, United States
- Future Biologics, Lawrenceville, GA, United States
- BioIntegrate, Lawrenceville, GA, United States
- Regenerative Orthopaedics, Noida, India
| | - Gregory Waryasz
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Peterson KS, Vacketta V, Kavanagh A. The Ankle Joint: Non-Operative Updates in Ankle Arthritis, Are Biologics Working? Clin Podiatr Med Surg 2023; 40:669-680. [PMID: 37716744 DOI: 10.1016/j.cpm.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
The vast majority of ankle arthritis is post-traumatic in nature, with rates of 60% to 80%. Symptoms include pain, decreased range of motion, and joint effusion. Diagnostic imaging is helpful in determining the degree of joint degeneration, with MRI and CT scan being the most sensitive. Conservative treatment modalities are targeted at reducing symptoms and improving function. Injectable therapy has gained popularity over the last few decades, with advancements in biologic treatments. Corticosteroids, hyaluronic acid, platelet-rich plasma, and amniotic tissue-derived products can be used to reduce inflammation in the joint, as well as prevent cartilage degeneration.
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Affiliation(s)
- Kyle S Peterson
- Suburban Orthopaedics, 1110 West Schick Road, Bartlett, IL 60103, USA.
| | - Vincent Vacketta
- Orthopedic Foot and Ankle Center Fellowship, 350 West Wilson Bridge Road, Suite. 200, Worthington, OH 43085, USA
| | - Amber Kavanagh
- Hinsdale Orthopaedics (IBJI) Foot and Ankle Fellowship, 951 Essington Road, Joliet, IL 60435, USA
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Parker EB, Hering KA, Chiodo CP, Smith JT, Bluman EM, Martin EA. Intraarticular Injections in the Foot and Ankle: Medication Selection Patterns and Perceived Risk Of Chondrotoxicity. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231216990. [PMID: 38145274 PMCID: PMC10748709 DOI: 10.1177/24730114231216990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Abstract
Background Intraarticular corticosteroid injections (ICIs) are widely used to treat foot and ankle conditions. Although laboratory studies indicate certain corticosteroids and local anesthetics used in ICIs are associated with chondrotoxic effects, and selected agents such as ropivacaine and triamcinolone may have less of these features, clinical evidence is lacking. We aimed to identify the patterns of drug selection, perceptions of injectate chondrotoxicity, and rationale for medication choice among surgeons in the American Orthopaedic Foot & Ankle Society (AOFAS). Methods An e-survey including demographics, practice patterns, and rationale was disseminated to 2011 AOFAS members. Frequencies and percentages were calculated for demographic data, anesthetic and steroid choice, rationale for injectate choice, and perception of chondrotoxicity. Bivariate analysis was used to identify practice patterns significantly associated with perceptions of injectate risk and rationale. Results In total, 387 surveys were completed. Lidocaine and triamcinolone were the most common anesthetic and corticosteroid used (51.2% and 39.3%, respectively). Less than half of respondents felt corticosteroids or local anesthetics bear risk of chondrotoxicity. Respondents agreeing that corticosteroids are chondrotoxic were more likely to use triamcinolone (P = .037). Respondents agreeing local anesthetics risk chondrotoxicity were less likely to use lidocaine (P = .023). Respondents choosing a local anesthetic based on literature were more likely to use ropivacaine (P < .001). Conclusion Corticosteroid and local anesthetic use in ICIs varied greatly. Rationale for ICI formulation was also variable, as the clinical implications are largely unknown. Those who recognized potential chondrotoxicity and who chose based on literature were more likely to choose ropivacaine and triamcinolone, as reflected in the basic science literature. Further clinical studies are needed to establish guidelines that shape foot and ankle ICI practices based on scientific evidence and reduce the variation identified by this study. Level of Evidence Level IV, cross-sectional survey study.
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Affiliation(s)
- Emily B. Parker
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kalei A. Hering
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher P. Chiodo
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeremy T. Smith
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric M. Bluman
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth A. Martin
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Sytsma TT, Greenlund LS, Fischer KM, McCoy RG. Impact of Intra-Articular Corticosteroid Injection on Glycemic Control: A Population-Based Cohort Study. Clin Diabetes 2023; 42:96-103. [PMID: 38230338 PMCID: PMC10788672 DOI: 10.2337/cd22-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
This retrospective cohort study investigated the longer-term hyperglycemic effects of intra-articular corticosteroid (IACS) administration by evaluating changes in A1C after large joint IACS injection. Among 1,169 patients (mean age 66.1 ± 12.2 years, 52.8% female), 184 (15.7%) experienced a greater-than-expected rise in A1C (actual A1C ≥0.5% above predicted) after IACS. Greater-than-expected rise in A1C was associated solely with baseline A1C (odds ratio [OR] 1.84, 95% CI 1.08-3.13 for baseline A1C of 7.0-8.0% compared with <7.0% and OR 4.79, 95% CI 2.83-8.14 for baseline A1C >8.0% compared with <7.0%). Although most patients do not experience an increase in A1C after IACS, clinicians should counsel patients with suboptimally controlled diabetes about risks of further hyperglycemia after IACS administration.
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Affiliation(s)
- Terin T. Sytsma
- Mayo Clinic Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Rochester, MN
| | - Laura S. Greenlund
- Mayo Clinic Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Rochester, MN
| | | | - Rozalina G. McCoy
- Mayo Clinic Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Rochester, MN
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
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Osborne B, Thoirs K, Dizon J, Parange N, Milanese S. Patient satisfaction and incidence of adverse events during a trial of sonographer administered musculoskeletal injections. SONOGRAPHY 2022. [DOI: 10.1002/sono.12306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Brooke Osborne
- Allied Health and Human Performance University of South Australia Adelaide South Australia Australia
| | - Kerry Thoirs
- Allied Health and Human Performance University of South Australia Adelaide South Australia Australia
| | - Janine Dizon
- International Centre for Allied Health Evidence University of South Australia Adelaide South Australia Australia
| | - Nayana Parange
- Allied Health and Human Performance University of South Australia Adelaide South Australia Australia
| | - Steve Milanese
- Allied Health and Human Performance University of South Australia Adelaide South Australia Australia
- International Centre for Allied Health Evidence University of South Australia Adelaide South Australia Australia
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Bharat KT, Manhas NS, Gutcho J, Lin J, Bhattacharyya S, Kounang R. Ingredients of a Natural Oral Nutritional Supplement and Their Role in the Treatment of Osteoarthritis. CLINICAL MEDICINE INSIGHTS: ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2022; 15:11795441211063365. [PMID: 35360183 PMCID: PMC8961370 DOI: 10.1177/11795441211063365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
Osteoarthritis is a prevalent degenerative disease affecting a large portion of
the world’s aging population. Currently, nonsteroidal anti-inflammatory drugs
and acetaminophen are first-line medications for treating osteoarthritis
patients’ pain. However, several studies have noted that while these medications
control pain they do not halt progressive degeneration and tend to have an
unfavorable side-effect profile with prolonged use. Recently, due to their more
favorable side-effect profiles, herbal alternatives for controlling
osteoarthritis symptoms and for alleviating the progression of the disease are
being increasingly studied. Synogesic is a newly developed herbal supplement
blend by renowned orthopedic surgeons and physiatrists consisting of turmeric,
rutin, ginger root, vitamin C, vitamin D, and boswellia extracts. A study by
Sharkey et al. has commented on the efficacy of the blend on the patients with
knee osteoarthritis. So far, a review on the ingredients of the blend has not
yet carried outbeen. By exploring prominent literature databases including
PubMed and ScienceDirect, our aim is to write a narrative review to explore the
individual ingredients of this blend and delve into their characteristics, as
well as the most recent literature on their mechanism and efficacy in patients
with osteoarthritis. Through this, we hope to inform clinicians and patients
alike on relevant up-to-date research on the supplement and provide insight on
the potential for this supplement for alleviating the disease course of patients
with osteoarthritis.
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Affiliation(s)
- Krish Tejas Bharat
- California University of Science and
Medicine, Colton, CA, USA
- Krish Tejas Bharat, California University
of Science and Medicine, 1501 Violet Street, Colton, CA 92324, USA.
| | | | - James Gutcho
- California University of Science and
Medicine, Colton, CA, USA
| | - Joshua Lin
- Keck School of Medicine, University of
Southern California, Los Angeles, CA, USA
| | | | - Robertus Kounang
- Loma Linda University Health,
Department of Physical Medicine & Rehabilitation, Loma Linda, CA, USA
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Shibuya N, McAlister JE, Prissel MA, Piraino JA, Joseph RM, Theodoulou MH, Jupiter DC. Consensus Statement of the American College of Foot and Ankle Surgeons: Diagnosis and Treatment of Ankle Arthritis. J Foot Ankle Surg 2021; 59:1019-1031. [PMID: 32778440 DOI: 10.1053/j.jfas.2019.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/20/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Naohiro Shibuya
- Professor, College of Medicine, Texas A&M University, Temple, TX.
| | | | - Mark A Prissel
- Faculty, Advanced Foot and Ankle Reconstruction Fellowship Program, Orthopedic Foot and Ankle Center, Worthington, OH
| | - Jason A Piraino
- Associate Professor, Department of Orthopaedic Surgery and Rehabilitation, University of Florida Health, Gainesville, FL
| | - Robert M Joseph
- Chairman, Department of Podiatric Medicine & Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL
| | - Michael H Theodoulou
- Chief, Division of Podiatric Surgery, Cambridge Health Alliance, Instructor of Surgery, Harvard Medical School, Cambridge, MA
| | - Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Community, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX
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Daniels TR, Wilson IR, Fu JM. What's New in Foot and Ankle Surgery. J Bone Joint Surg Am 2020; 102:856-865. [PMID: 32187125 DOI: 10.2106/jbjs.20.00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Timothy R Daniels
- Division of Orthopaedic Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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